{"hospital_name":"Adventhealth Redmond","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Redmond"],"hospital_address":["501 Redmond Road Nw, Rome, GA 30165"],"license_information":{"license_number":"057-266","state":"GA"},"type_2_npi":["1508810565","1548214257"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health Plans","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014960","type":"NDC"}],"standard_charges":[{"gross_charge":520.29,"discounted_cash":520.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"GADOTERATE MEGLUMINE 50 MMOL/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"65219008850","type":"NDC"}],"standard_charges":[{"gross_charge":148.15,"discounted_cash":148.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270701546","type":"NDC"}],"standard_charges":[{"gross_charge":243.54,"discounted_cash":243.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"63323048557","type":"NDC"}],"standard_charges":[{"gross_charge":22.12,"discounted_cash":22.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":81.67,"discounted_cash":81.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"LIPIODOL 480 MG/ML IJ OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":14937.12,"discounted_cash":14937.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"LABETALOL HCL 20 MG/4ML IV 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Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"GNP DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122075252","type":"NDC"}],"standard_charges":[{"gross_charge":197.34,"discounted_cash":197.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"VOLTAREN ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":15.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 GR"}]},{"description":"GNP ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"gross_charge":226.5,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"HEMORRHOIDAL 0.25-14-74.9 % RE OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536128806","type":"NDC"}],"standard_charges":[{"gross_charge":87.01,"discounted_cash":87.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"GNP LIDOCAINE PAIN RELIEVING 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122061410","type":"NDC"}],"standard_charges":[{"gross_charge":89.69,"discounted_cash":89.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76.5 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":212.89,"discounted_cash":212.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":293.68,"discounted_cash":293.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"PROCTOZONE-HC 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":188.59,"discounted_cash":188.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"DESITIN DAILY DEFENSE 13 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"74300000301","type":"NDC"}],"standard_charges":[{"gross_charge":156.71,"discounted_cash":156.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"HURRICAINE 20 % MT AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":774.39,"discounted_cash":774.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA 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Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":171.16,"discounted_cash":171.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067831","type":"NDC"}],"standard_charges":[{"gross_charge":194.42,"discounted_cash":194.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128202","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":81.35,"discounted_cash":81.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"53329008701","type":"NDC"}],"standard_charges":[{"gross_charge":73.16,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":100.48,"discounted_cash":100.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":65.49,"discounted_cash":65.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":153.58,"discounted_cash":153.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":67.32,"discounted_cash":67.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802086801","type":"NDC"}],"standard_charges":[{"gross_charge":101.44,"discounted_cash":101.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 119 GR"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":120.1,"discounted_cash":120.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 GR"}]},{"description":"MENTHOL-ZINC OXIDE 0.44-20.625 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10135070104","type":"NDC"}],"standard_charges":[{"gross_charge":117.94,"discounted_cash":117.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014303","type":"NDC"}],"standard_charges":[{"gross_charge":83.11,"discounted_cash":83.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":95.6,"discounted_cash":95.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129497","type":"NDC"}],"standard_charges":[{"gross_charge":258.9,"discounted_cash":258.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":216.78,"discounted_cash":216.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":108.18,"discounted_cash":108.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":161.4,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"gross_charge":431.84,"discounted_cash":431.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"BAZA ANTIFUNGAL 2 % EX 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Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":49.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":71.91,"discounted_cash":71.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":262.14,"discounted_cash":262.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":49.14,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"AQUAPHOR ADVANCED THERAPY EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72140063377","type":"NDC"}],"standard_charges":[{"gross_charge":256.31,"discounted_cash":256.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":199.28,"discounted_cash":199.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":199.28,"discounted_cash":199.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":70.11,"discounted_cash":70.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":259.55,"discounted_cash":259.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762013102","type":"NDC"}],"standard_charges":[{"gross_charge":223.26,"discounted_cash":223.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":223.26,"discounted_cash":223.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":317.63,"discounted_cash":317.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"gross_charge":238.16,"discounted_cash":238.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":287.25,"discounted_cash":287.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLINDAMYCIN PHOS (TWICE-DAILY) 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"gross_charge":209.98,"discounted_cash":209.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":125.41,"discounted_cash":125.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":232.33,"discounted_cash":232.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":112.78,"discounted_cash":112.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":270.28,"discounted_cash":270.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":275.59,"discounted_cash":275.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672200201","type":"NDC"}],"standard_charges":[{"gross_charge":77.77,"discounted_cash":77.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291007715","type":"NDC"}],"standard_charges":[{"gross_charge":80.21,"discounted_cash":80.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"AMERICAINE 20 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63736037882","type":"NDC"}],"standard_charges":[{"gross_charge":111.9,"discounted_cash":111.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":73.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"gross_charge":195.4,"discounted_cash":195.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"AYR SALINE NASAL NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":85.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.1 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":203.17,"discounted_cash":203.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"gross_charge":186.16,"discounted_cash":186.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125802","type":"NDC"}],"standard_charges":[{"gross_charge":233.3,"discounted_cash":233.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64380078932","type":"NDC"}],"standard_charges":[{"gross_charge":272.78,"discounted_cash":272.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":278.99,"discounted_cash":278.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180095601","type":"NDC"}],"standard_charges":[{"gross_charge":173.04,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"gross_charge":368.15,"discounted_cash":368.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":158.45,"discounted_cash":158.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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schedule","standard_charge_dollar":31.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27.73}]}]},{"description":"Injection for knee x-ray","code_information":[{"code":"27370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1277.0,"maximum":1277.0,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":1277.0}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14000.7,"maximum":45246.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33487.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24334.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30416.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30835.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26881.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20601.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18458.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14000.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22876.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18817.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41577.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15015.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44833.57},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17921.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45246.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":8215.4,"10th_percentile":8215.4,"90th_percentile":8215.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7918.48,"maximum":25590.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18939.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13762.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17202.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17440.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11651.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7918.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12938.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10642.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9075.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25356.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25590.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6050.8,"maximum":19554.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14472.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10516.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13145.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13326.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11617.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8903.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6050.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9886.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8132.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17968.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7526.77},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19376.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19554.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11966.75,"maximum":38673.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28622.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20798.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25997.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26356.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22976.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17608.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15777.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11966.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19553.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16083.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35537.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13304.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38320.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38673.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13810.64,"10th_percentile":13810.64,"90th_percentile":13810.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15559.15,"10th_percentile":15559.15,"90th_percentile":15559.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":7639.17,"10th_percentile":7639.17,"90th_percentile":7639.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6420.02,"maximum":20747.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15355.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11158.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13947.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14139.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12326.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9446.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6420.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10490.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19065.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7427.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20558.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20747.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7310.41,"10th_percentile":7310.41,"90th_percentile":7310.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7401.63,"10th_percentile":7401.63,"90th_percentile":7401.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":40758.41,"10th_percentile":40758.41,"90th_percentile":40758.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7550.91,"10th_percentile":7550.91,"90th_percentile":7550.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7253.27,"10th_percentile":7249.27,"90th_percentile":7546.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4126.83,"maximum":13336.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9870.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7172.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8965.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9089.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7923.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6072.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4126.83},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6743.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5546.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12255.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4853.73},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13215.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13336.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12845.27,"maximum":41512.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30724.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22325.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27906.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28291.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18900.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12845.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20988.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17264.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38146.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14189.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41133.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16442.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41512.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7092.98,"maximum":22922.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16965.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12328.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15621.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13618.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10436.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9351.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7092.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11589.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21063.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8093.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22713.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9079.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22922.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4761.82,"maximum":15388.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11389.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8276.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10345.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10487.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9142.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7006.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4761.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7780.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6400.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14141.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5576.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15248.49},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6095.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15388.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6683.83,"maximum":21600.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15986.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11616.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14520.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14720.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12833.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9834.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6683.83},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10921.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19848.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7686.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21403.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8555.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21600.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7538.3,"10th_percentile":7538.3,"90th_percentile":7538.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11607.35,"maximum":37511.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27763.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20174.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25217.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25564.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22286.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17079.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11607.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18966.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15600.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34469.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12970.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37169.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37511.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4587.69,"maximum":14826.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10973.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7973.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9966.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10104.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8808.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6750.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6048.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4587.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7496.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13623.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5617.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14690.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14826.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6547.67,"maximum":21160.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15661.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11380.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14224.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14420.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9634.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6547.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10698.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8800.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7991.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20967.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21160.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10421.15,"maximum":33678.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24925.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18112.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22640.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22952.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20009.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15333.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10421.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17028.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30947.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14309.36},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33371.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13339.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33678.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":309.91,"10th_percentile":309.91,"90th_percentile":309.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14948.21,"10th_percentile":14948.21,"90th_percentile":14948.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15804.88,"maximum":51076.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37803.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27469.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34336.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34809.38},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30345.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23255.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20837.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15804.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25824.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21242.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46935.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50610.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20230.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51076.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22510.31,"maximum":72747.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53841.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39124.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48903.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49577.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43220.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33122.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29678.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22510.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":36781.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30254.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66848.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72083.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":28813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72747.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9151.16,"maximum":29573.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21888.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15905.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19880.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20154.92},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17570.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13465.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12065.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9151.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14952.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27175.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10310.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29304.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29573.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15223.56,"maximum":49198.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36412.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26459.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33073.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33529.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29229.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22400.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20071.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15223.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24875.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16916.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48749.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49198.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28756.85,"maximum":92934.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":68782.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49981.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62474.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63335.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":55214.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":42313.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37913.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28756.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":46988.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38650.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85398.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30648.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92086.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":36809.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92934.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8804.85,"maximum":28454.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21060.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15303.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19128.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19392.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16905.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12955.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8804.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14387.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26147.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10316.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28195.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28454.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11013.6,"maximum":35592.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26343.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19142.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23927.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24256.84},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16205.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11013.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17996.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32706.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12945.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35268.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14097.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35592.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18997.54,"maximum":61394.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45439.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33018.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41272.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41841.04},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36476.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27953.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25046.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18997.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31041.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25533.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22302.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60834.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61394.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7644.84,"maximum":24705.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18285.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13287.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16608.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16837.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14678.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11248.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7644.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12491.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10274.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22702.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8094.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24480.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9785.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24705.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9979.93,"maximum":32252.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23870.62},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17345.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21681.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21980.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19161.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14684.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13157.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9979.93},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16307.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13413.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29637.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10962.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31958.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32252.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16312.87,"maximum":52718.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39018.17},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28352.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35439.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35928.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31321.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24003.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21507.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16312.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26655.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21924.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48443.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18336.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52237.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20880.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52718.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5699.26,"maximum":18418.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13631.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9905.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12381.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12552.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10942.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8386.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7514.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5699.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9312.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16924.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7373.43},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18250.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7295.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18418.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8567.88,"maximum":27688.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20493.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14891.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18613.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18870.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16450.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12607.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11296.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8567.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13999.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25443.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10593.71},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27436.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27688.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15027.82,"maximum":48565.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35944.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26119.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32648.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33097.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28854.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22112.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15027.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24555.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19817.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48122.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48565.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7765.29,"maximum":25095.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18573.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13496.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16870.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17102.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14909.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11426.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7765.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12688.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23060.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9642.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24866.31},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25095.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9850.31,"maximum":31833.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23560.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17120.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21399.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21694.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18912.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14494.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12986.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9850.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16095.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13239.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29252.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12277.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31543.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31833.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16907.94,"maximum":54641.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40441.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29387.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36732.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37238.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32463.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24878.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22291.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16907.94},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27627.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22724.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50210.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22514.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54143.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54641.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.66,"maximum":32474.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24035.03},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17465.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21830.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22131.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19293.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14785.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10048.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16419.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29841.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12325.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32178.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32474.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13804.31,"maximum":44611.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33018.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23992.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29989.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30403.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26504.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20312.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18199.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13804.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22556.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40994.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17035.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44204.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44611.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23376.4,"maximum":75545.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55913.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40629.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50785.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51485.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44883.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34396.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30820.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23376.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38196.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31418.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69419.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30407.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74856.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75545.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10722.28,"maximum":34651.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25646.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18636.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23294.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23615.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20587.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15777.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14136.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10722.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17520.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14411.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11578.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34335.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13724.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34651.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15332.88,"maximum":49551.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36674.17},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26649.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33310.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33769.84},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29439.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22561.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15332.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25053.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45533.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17012.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49099.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49551.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23702.41,"maximum":76599.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56692.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41196.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51493.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52203.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45509.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34876.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31249.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23702.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38729.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31856.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70388.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26248.61},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75900.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30339.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76599.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11016.87,"maximum":35603.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26350.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19148.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23934.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24264.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21152.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16210.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11016.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18001.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14806.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32716.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12697.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35278.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14101.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35603.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12544.8,"10th_percentile":12544.8,"90th_percentile":12544.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15692.93,"maximum":50715.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37535.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27275.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34092.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34562.83},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30131.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23091.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15692.93},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25642.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46602.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18993.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50252.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50715.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10144.91,"10th_percentile":10144.91,"90th_percentile":10144.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30090.34,"maximum":97243.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71972.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52298.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65371.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66272.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":57774.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":44275.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39671.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30090.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":49167.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89358.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36887.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96356.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38516.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97243.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33944.86,"10th_percentile":33944.86,"90th_percentile":33944.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10489.23,"maximum":33898.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25088.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18230.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22787.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23101.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20139.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15434.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10489.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17139.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31149.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11839.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33589.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13426.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33898.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16000.61,"maximum":51709.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38271.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27810.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34761.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35240.48},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30721.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23543.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21095.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16000.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26144.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21505.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47516.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19340.49},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51237.76},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51709.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32649.32,"maximum":105513.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":78092.71},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56746.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70930.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71908.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":62687.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":48041.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43045.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32649.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":53348.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43881.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96957.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39618.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":104550.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":41791.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105513.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21016.43,"maximum":67919.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50268.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36527.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45658.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46287.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40352.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30924.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21016.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34340.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28246.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62411.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67299.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67919.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20627.58,"maximum":66662.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49338.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35852.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44813.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45431.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39605.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30352.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20627.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33705.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27724.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61256.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66054.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66662.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28328.72,"maximum":91550.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67758.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49237.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61544.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62392.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":54392.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":41683.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37349.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28328.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":46288.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38074.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84126.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90715.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":36261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91550.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11541.23,"maximum":37298.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27605.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20059.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25073.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25418.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22159.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16982.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15216.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11541.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18858.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15511.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34273.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36957.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37298.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":1294.8,"10th_percentile":1294.8,"90th_percentile":1294.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13319.56,"10th_percentile":13319.56,"90th_percentile":13319.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":27108.09,"10th_percentile":27108.09,"90th_percentile":27108.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13026.42,"10th_percentile":13026.42,"90th_percentile":13026.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":21450.64,"10th_percentile":21450.64,"90th_percentile":21450.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":24747.93,"10th_percentile":24747.93,"90th_percentile":24747.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17811.34,"maximum":57561.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42602.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30957.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38695.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39228.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34198.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26208.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23482.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17811.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29103.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23938.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52893.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57036.13},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22798.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57561.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23505.49,"10th_percentile":23505.49,"90th_percentile":23505.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20526.86,"10th_percentile":20526.86,"90th_percentile":72537.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20087.77,"10th_percentile":13029.21,"90th_percentile":20102.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":49500.0,"10th_percentile":49500.0,"90th_percentile":49500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15745.96,"maximum":50886.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37662.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27367.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34208.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34679.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30232.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23169.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20759.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15745.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25728.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21163.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46760.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17647.66},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50422.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20155.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50886.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29215.75,"maximum":94417.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":69880.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50778.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63471.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64346.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":56095.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":42988.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38518.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29215.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":47738.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39266.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86760.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30824.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93555.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":37396.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94417.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15856.59,"maximum":51244.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37926.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27559.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34448.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34923.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30445.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23331.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20905.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15856.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25909.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21311.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47088.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50776.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51244.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43772.24,"maximum":141459.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":104697.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76079.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95095.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96405.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":84044.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":64407.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57710.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43772.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":71523.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":140169.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":56029.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141459.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4465.27,"maximum":14430.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10680.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7760.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9700.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9834.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8573.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6570.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5887.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4465.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7296.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13260.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5579.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14298.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5715.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14430.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6306.11,"maximum":20379.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15083.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10960.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13888.86},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12107.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9278.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8314.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6306.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10304.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18727.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7294.5},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20193.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8071.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20379.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13650.47,"maximum":44114.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32650.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23725.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29655.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30064.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26209.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20085.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13650.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22304.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18346.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40537.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15255.75},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43712.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44114.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":23725.4,"10th_percentile":23725.4,"90th_percentile":23725.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4713.38,"maximum":15232.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11273.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8192.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10239.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10380.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9049.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6935.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6214.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4713.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7701.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6334.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13997.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5376.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15093.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6033.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15232.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":10325.92,"10th_percentile":10325.92,"90th_percentile":10325.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5705.81,"maximum":18439.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13647.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9917.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12395.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12566.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10955.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8395.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7522.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5705.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9323.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16944.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6138.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18271.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18439.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":8395.69,"10th_percentile":8395.69,"90th_percentile":8395.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6447.19,"10th_percentile":6447.19,"90th_percentile":6450.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4594.89,"maximum":14849.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10990.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7986.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9982.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10119.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8822.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6761.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6058.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4594.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7507.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6175.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13645.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5149.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14713.93},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5881.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14849.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3705.89,"maximum":11976.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8863.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6441.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8051.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8162.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7115.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5452.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3705.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6055.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4980.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11005.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4204.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11867.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11976.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4219.88,"10th_percentile":4219.88,"90th_percentile":4219.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9298.64,"10th_percentile":9298.64,"90th_percentile":9298.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":9253.21,"10th_percentile":9253.21,"90th_percentile":9253.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4816.16,"maximum":15564.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11519.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8370.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10463.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10607.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9247.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7086.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6349.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4816.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7869.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14302.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5685.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15422.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15564.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4527.5,"10th_percentile":4527.5,"90th_percentile":4527.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":7869.53,"10th_percentile":7869.53,"90th_percentile":7869.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7881.82,"maximum":25471.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18852.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13699.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17123.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17359.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15133.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11597.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7881.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12878.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10593.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23406.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8927.94},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25239.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25471.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9094.11,"10th_percentile":9094.11,"90th_percentile":9094.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8885.19,"10th_percentile":8885.19,"90th_percentile":8909.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6416.89,"10th_percentile":6416.89,"90th_percentile":6416.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5978.14,"maximum":19319.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14298.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10390.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12987.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13166.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8796.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7881.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5978.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9768.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17753.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6631.5},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19143.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7652.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19319.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10315.75,"maximum":33337.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24673.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17929.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22411.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22719.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19806.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15178.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13600.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10315.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16855.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30634.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10632.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33033.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33337.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":21733.88,"10th_percentile":21733.88,"90th_percentile":21733.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4943.16,"maximum":15974.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11823.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8591.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10739.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10887.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9491.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7273.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4943.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8077.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6643.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14679.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5498.69},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15829.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6327.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15974.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":10739.03,"10th_percentile":10739.03,"90th_percentile":10739.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5628.73,"10th_percentile":5628.73,"90th_percentile":5628.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":932.28,"10th_percentile":932.28,"90th_percentile":932.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":11862.0,"10th_percentile":11862.0,"90th_percentile":11862.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5591.19,"10th_percentile":5591.19,"90th_percentile":5594.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6503.09,"10th_percentile":6503.09,"90th_percentile":6503.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7790.17,"maximum":25175.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18633.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13539.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16924.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17157.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14957.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11462.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7790.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12729.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10470.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23134.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8204.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24945.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25175.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8870.59,"10th_percentile":8870.59,"90th_percentile":8870.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8700.98,"10th_percentile":8700.98,"90th_percentile":8700.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4407.01,"maximum":14242.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10540.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7659.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9574.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9706.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8461.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6484.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4407.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7200.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13087.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5079.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14112.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14242.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7833.37,"maximum":25315.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18736.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13614.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17018.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17252.58},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15040.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11526.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10327.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7833.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12799.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23262.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8285.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25084.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10026.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25315.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4711.42,"maximum":15225.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11269.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8188.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10376.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6932.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6211.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4711.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7698.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13991.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5455.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15087.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15225.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5364.85,"10th_percentile":5364.85,"90th_percentile":5364.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":6932.51,"10th_percentile":6932.51,"90th_percentile":6932.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6988.24,"maximum":22584.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16714.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12146.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15181.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15391.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13417.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10282.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9213.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6988.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11418.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20752.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7724.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22378.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22584.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23078.54,"10th_percentile":23078.54,"90th_percentile":23078.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6267.86,"10th_percentile":6267.86,"90th_percentile":6267.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10688.24,"maximum":34541.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25564.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18576.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23220.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23540.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20521.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15726.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14091.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10688.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17464.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31740.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10897.39},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34226.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34541.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2979.25,"maximum":9628.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":7125.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5178.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6472.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6561.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":5720.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":4383.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3927.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":2979.25},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":4868.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8847.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3782.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9540.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":3813.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9628.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4150.39,"maximum":13412.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9927.17},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7213.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9016.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9141.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6107.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4150.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6781.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12325.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5434.79},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13290.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13412.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10224.76,"maximum":33043.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24456.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17771.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22213.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22519.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15045.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13480.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10224.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16707.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13742.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30364.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11804.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32742.11},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33043.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3705.24,"maximum":11974.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8862.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6439.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8049.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8160.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7114.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5452.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3705.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6054.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4979.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11003.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4925.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11865.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11974.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5557.86,"maximum":17961.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13293.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9659.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12074.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12240.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10671.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8177.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7327.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5557.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9081.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6806.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17797.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7114.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17961.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":9659.92,"10th_percentile":9659.92,"90th_percentile":9659.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":13074.83,"10th_percentile":13074.83,"90th_percentile":13074.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8404.22,"maximum":27160.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20101.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14607.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18258.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18509.83},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12366.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8404.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13732.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11295.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24957.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10116.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26912.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10757.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27160.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9803.48,"10th_percentile":9803.48,"90th_percentile":9803.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9070.44,"10th_percentile":9070.44,"90th_percentile":9070.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9677.15,"10th_percentile":9677.15,"90th_percentile":9677.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9474.1,"10th_percentile":9474.1,"90th_percentile":9474.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6478.28,"10th_percentile":6478.28,"90th_percentile":6478.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6086.15,"maximum":19668.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14557.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10578.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13222.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13404.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11685.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8955.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8024.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6086.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9944.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18073.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7521.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19489.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7790.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19668.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11173.98,"maximum":36111.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26726.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19421.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24275.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24610.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21454.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16441.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11173.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18258.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15018.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33182.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12506.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35781.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14302.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36111.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17715.76,"maximum":57252.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42373.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30791.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38487.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39017.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26067.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23356.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17715.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28947.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23810.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52609.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19975.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56730.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57252.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7005.26,"maximum":22639.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16755.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12175.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15218.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15428.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10307.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7005.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11446.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20803.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8661.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22432.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22639.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8051.8,"10th_percentile":8051.8,"90th_percentile":8051.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":10307.74,"10th_percentile":9298.64,"90th_percentile":10307.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":10666.49,"10th_percentile":10666.49,"90th_percentile":10666.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7900.81,"10th_percentile":7897.05,"90th_percentile":7918.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14485.79,"maximum":46814.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34648.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25177.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31470.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31904.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27813.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21314.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19098.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14485.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23669.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19469.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16517.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46386.93},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18542.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46814.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":21314.8,"10th_percentile":21314.8,"90th_percentile":21314.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":23759.0,"10th_percentile":23759.0,"90th_percentile":23759.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16351.46,"10th_percentile":16338.71,"90th_percentile":16494.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3892.3,"maximum":12670.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9377.58},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6814.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8517.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8634.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7527.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5768.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3920.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6406.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5269.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11642.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3892.3},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12554.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12670.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4531.39,"maximum":14644.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10838.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7875.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9844.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9980.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8700.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6667.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4531.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7404.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13456.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5452.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14510.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14644.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12967.03,"maximum":41905.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31015.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22537.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28170.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28559.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24897.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19080.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17096.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12967.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21187.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13528.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41523.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41905.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4733.67,"maximum":15297.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11322.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8227.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10283.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10425.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9088.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6965.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4733.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7734.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14057.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5546.79},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15158.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15297.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9298.64,"10th_percentile":9298.64,"90th_percentile":9298.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6250.07,"10th_percentile":6250.07,"90th_percentile":6250.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6016.76,"maximum":19444.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14391.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10457.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13071.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13251.58},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8853.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7932.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6016.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9831.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17867.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7281.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19267.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7701.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6938.42,"10th_percentile":6938.42,"90th_percentile":6938.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9298.64,"10th_percentile":9298.64,"90th_percentile":9298.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6797.71,"10th_percentile":6790.21,"90th_percentile":6804.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10501.02,"maximum":33936.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25117.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18251.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22813.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23127.91},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15451.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13844.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10501.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17158.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14113.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31184.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12259.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33626.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33936.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12069.79,"10th_percentile":11775.3,"90th_percentile":12119.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":17158.51,"10th_percentile":17158.51,"90th_percentile":17158.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5435.17,"10th_percentile":1440.0,"90th_percentile":11861.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":14802.35,"10th_percentile":14802.35,"90th_percentile":14802.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":12038.15,"10th_percentile":7220.0,"90th_percentile":61132.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23608.79,"maximum":76297.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56469.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41033.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51290.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51997.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45329.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34738.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31126.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23608.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38576.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31730.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70110.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75600.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76297.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36438.35,"maximum":117758.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":87155.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63332.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79162.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80253.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":69963.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":53616.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48041.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36438.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":59539.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48974.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108209.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":116684.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":46642.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117758.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30234.36,"maximum":97708.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72316.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52549.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65684.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66589.53},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":58051.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":44487.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30234.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":49402.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40635.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89785.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96817.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97708.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39321.37,"maximum":127075.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":94051.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68343.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85425.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86603.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":75498.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":57858.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51842.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39321.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":64250.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52849.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116771.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":125916.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":50332.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127075.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44327.08,"10th_percentile":44327.08,"90th_percentile":44327.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46678.17,"maximum":150850.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":111647.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81129.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101408.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":102806.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":89623.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":68683.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61541.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46678.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":76271.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62736.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138618.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":149474.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":59749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150850.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21548.65,"maximum":69639.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51541.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37452.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46814.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47459.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":41374.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31707.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28410.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21548.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":35210.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28961.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63992.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23752.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69003.91},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27582.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69639.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24537.23,"10th_percentile":24537.23,"90th_percentile":24537.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":35316.48,"10th_percentile":35316.48,"90th_percentile":35316.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24295.46,"10th_percentile":24295.46,"90th_percentile":24295.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27007.01,"maximum":87279.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":64597.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46939.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58672.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59481.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":51854.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":39738.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35606.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27007.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44129.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36298.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80201.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27890.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86482.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":34569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87279.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16712.86,"maximum":54011.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39974.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29048.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36308.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36809.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32089.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24591.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22034.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16712.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27308.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22462.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19553.97},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53518.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54011.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23280.82,"maximum":75237.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55684.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40463.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50577.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51274.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44700.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34256.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30694.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23280.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38040.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31290.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69136.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26670.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74550.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75237.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6463.7,"10th_percentile":6463.7,"90th_percentile":6463.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":47761.75,"10th_percentile":47761.75,"90th_percentile":47761.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34540.56,"maximum":111625.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":82616.31},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60033.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75039.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76073.69},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":66319.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":50823.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45539.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34540.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":56438.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46423.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102573.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38413.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":110607.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":44212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111625.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27646.59,"maximum":89346.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66126.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48051.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60062.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60890.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":53082.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40679.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36450.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27646.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45174.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37157.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82101.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32070.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88530.94},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89346.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45025.21,"maximum":145508.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":107694.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78256.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97817.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":99165.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":86450.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":66251.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59362.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45025.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":73570.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60515.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133709.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":50984.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":144181.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":57633.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145508.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31165.91,"maximum":100719.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":74544.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54168.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67708.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68641.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":59839.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":45858.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41089.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31165.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":50924.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41887.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92552.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42663.49},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":99800.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":39893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100719.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":154570.08,"10th_percentile":154570.08,"90th_percentile":154570.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35153.97,"10th_percentile":35153.97,"90th_percentile":35153.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40118.71,"maximum":129652.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":95958.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69728.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87158.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88359.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":77029.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":59031.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52893.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":40118.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":65553.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53920.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119138.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":53531.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":128469.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":51353.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129652.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40948.29,"10th_percentile":40703.35,"90th_percentile":45605.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23462.81,"maximum":76546.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56653.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41167.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51458.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52167.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45478.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34852.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23686.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38702.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31834.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70339.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23462.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75848.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76546.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21868.77,"maximum":70673.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52307.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38009.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47510.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48164.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":41988.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":32178.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28832.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21868.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":35733.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29392.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64942.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24415.97},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70029.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70673.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17732.6,"maximum":64682.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47872.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34787.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43482.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44081.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":38429.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29450.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26388.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20014.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32703.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26900.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59437.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17732.6},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64092.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64682.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10669.91,"maximum":34482.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25520.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18545.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23180.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23499.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20486.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15700.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10669.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17434.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12610.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34167.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34482.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12375.89,"maximum":39995.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29601.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21510.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26886.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27257.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23762.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18210.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16316.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12375.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20222.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36752.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14646.87},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39630.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39995.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21294.0,"maximum":68816.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50932.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37010.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46261.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46898.87},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40885.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31332.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28074.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21294.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34794.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28619.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63235.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27809.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68188.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27256.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68816.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13237.39,"maximum":42779.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31662.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23007.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28758.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29154.64},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25416.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19477.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13237.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21629.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17791.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39310.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15654.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42389.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16944.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42779.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20569.32,"maximum":66474.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49199.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35750.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44686.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45302.8},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39493.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30266.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27119.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20569.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33609.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27645.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61083.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22992.25},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65867.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66474.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7149.93,"maximum":23106.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17101.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12427.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15747.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13728.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10520.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7149.93},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11682.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8527.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22895.79},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9152.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23106.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11115.06,"maximum":35920.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26585.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19318.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24147.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24480.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21341.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16355.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14654.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11115.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18161.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14938.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12902.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35593.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14227.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35920.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17658.15,"maximum":57066.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42235.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30691.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38362.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38891.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":33904.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":25982.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23280.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17658.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28853.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23733.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52438.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19917.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56545.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57066.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11663.65,"maximum":37693.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27897.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20272.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25339.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25688.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17162.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11663.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19058.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15676.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34637.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13681.69},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37349.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37693.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22566.53,"10th_percentile":22566.53,"90th_percentile":22566.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16991.73,"maximum":54912.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40641.9},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29532.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36914.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37423.36},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32624.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":25002.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22402.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16991.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27764.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22837.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19593.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54411.56},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54912.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22835.67,"maximum":73798.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54619.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39689.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49610.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50294.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43845.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33601.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30107.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22835.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":37313.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30691.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67814.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24658.77},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73125.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29230.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73798.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22581.53,"10th_percentile":22581.53,"90th_percentile":22581.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9783.54,"maximum":31617.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23400.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17004.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21254.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21547.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18784.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14395.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12898.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9783.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15986.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29053.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12651.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31329.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12523.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31617.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11036.99,"10th_percentile":11036.99,"90th_percentile":11036.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14287.43,"maximum":46172.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34173.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24832.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31039.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31467.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27432.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21022.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18836.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14287.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23345.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42428.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19169.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45751.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46172.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":19442.95,"10th_percentile":19442.95,"90th_percentile":19442.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16113.44,"10th_percentile":16113.44,"90th_percentile":16113.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29867.11,"maximum":96522.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71438.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51910.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64886.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65780.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":57346.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43947.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29867.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":48802.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40142.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88695.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39147.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95641.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38230.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96522.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11832.55,"maximum":38239.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28301.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20565.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25706.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26060.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22718.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17410.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15600.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11832.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19334.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35138.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15600.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37890.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38239.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13949.64,"maximum":45081.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33365.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24245.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30305.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30723.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26783.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20525.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13949.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22793.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18748.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41425.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19013.5},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44670.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45081.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20901.22,"maximum":67546.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49992.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36327.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45408.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46033.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30754.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27556.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20901.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34152.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28091.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62069.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27896.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66930.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67546.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23584.93,"10th_percentile":23580.76,"90th_percentile":23585.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9062.78,"maximum":29288.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21676.94},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15751.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19688.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19960.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17400.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13335.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11948.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9062.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14808.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12180.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26913.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11398.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29021.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11600.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29288.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18660.4,"maximum":60305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44633.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32432.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40539.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41098.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":35828.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27457.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24602.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18660.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30490.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25080.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55415.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20746.92},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59755.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60305.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20375.08,"10th_percentile":20375.08,"90th_percentile":20375.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21055.87,"10th_percentile":21055.87,"90th_percentile":21055.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32219.22,"maximum":104123.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":77063.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55999.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69996.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70961.07},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":61862.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":47408.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42478.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32219.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":52645.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43303.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95680.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35102.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103173.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":41241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104123.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27421.39,"maximum":88618.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65588.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47660.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59573.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60394.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52650.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40348.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36153.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27421.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44806.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36855.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30286.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87809.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88618.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":142790.38,"10th_percentile":142790.38,"90th_percentile":142790.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":101737.4,"10th_percentile":101737.4,"90th_percentile":101737.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":93326.94,"10th_percentile":93326.94,"90th_percentile":93326.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35163.71,"10th_percentile":35163.71,"90th_percentile":35163.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38417.97,"maximum":124156.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":91890.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66772.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83463.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84613.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":73764.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":56529.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50651.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38417.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":62774.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51634.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":44234.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":123023.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":49176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124156.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":138181.21,"10th_percentile":138181.21,"90th_percentile":138181.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43332.62,"10th_percentile":43332.62,"90th_percentile":43332.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35760.8,"maximum":115568.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":85534.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62154.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77690.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78761.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":68662.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":52619.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47148.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35760.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":58432.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48063.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106197.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39135.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114514.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":45774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115568.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":88390.82,"10th_percentile":88390.82,"90th_percentile":88390.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50048.23,"maximum":161741.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":119708.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86987.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108730.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":110228.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":96094.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":73642.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65984.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":50048.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":81778.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67266.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148626.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":58398.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":160266.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":64063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161741.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56443.44,"10th_percentile":56443.44,"90th_percentile":56443.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39687.96,"maximum":128260.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":94928.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68980.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86222.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87410.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":76202.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":58397.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52325.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39687.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":64849.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53341.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117859.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45000.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":127090.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":50801.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128260.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55185.16,"maximum":178342.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":131995.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95915.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119890.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121542.3},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":105957.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":81201.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72757.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":55185.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":90171.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74170.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163881.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":61725.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":176715.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":70638.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178342.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20617.76,"maximum":66630.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49314.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35835.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44792.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45409.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39586.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30337.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27183.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20617.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33689.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27710.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61227.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30856.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66022.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66630.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32387.46,"maximum":104667.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":77466.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56291.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70361.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71331.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":62185.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":47655.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42700.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32387.46},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":52920.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43529.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":47254.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103712.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":41456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104667.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32994.96,"maximum":106630.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":78919.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57347.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71681.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72669.6},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":63351.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":48549.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43501.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32994.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":53913.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44346.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97983.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34549.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":105657.71},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":42234.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106630.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34910.43,"maximum":112820.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":83500.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60676.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75843.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76888.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":67029.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":51368.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46026.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34910.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":57043.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46920.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103672.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39884.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":111791.49},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":44686.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112820.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":248291.65,"10th_percentile":248291.65,"90th_percentile":248291.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50264.92,"maximum":162442.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":120226.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87363.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109200.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":110705.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":96510.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":73961.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66270.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":50264.92},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":82132.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67557.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149269.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":58934.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":160960.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":64340.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162442.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57236.15,"10th_percentile":57236.15,"90th_percentile":57236.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40602.32,"maximum":139107.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":102956.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74813.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93513.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94802.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":82646.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":63336.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56750.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43044.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":70333.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57852.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127826.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":40602.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137838.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139107.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43044.28,"maximum":139107.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":102956.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74813.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93513.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94802.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":82646.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":63336.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56750.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43044.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":70333.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57852.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127826.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":50000.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137838.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":55097.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139107.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64041.73,"maximum":206964.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":153179.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111308.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139130.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":141048.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":122962.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":94232.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84434.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":64041.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":104643.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86073.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190182.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":75488.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":205076.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":81975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206964.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89085.86,"10th_percentile":89085.86,"90th_percentile":89085.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65182.11,"maximum":210650.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":155906.71},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113290.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141608.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":143560.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":125152.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":95910.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":65182.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":106506.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87606.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193568.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":96864.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":208728.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":83434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210650.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":353253.89,"10th_percentile":353253.89,"90th_percentile":353253.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37359.42,"maximum":120735.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":89358.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64933.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81163.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82282.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":71731.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":54971.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49255.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37359.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":61044.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110944.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":119633.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":47821.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120735.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71185.77,"maximum":230052.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":170266.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":123725.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154651.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":156782.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":136679.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":104744.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":71185.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":116316.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95675.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":227953.76},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":91119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230052.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":55851.45,"10th_percentile":55851.45,"90th_percentile":55851.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74096.94,"maximum":239460.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":177229.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128785.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160975.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":163194.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":142269.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":109028.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97691.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":74096.94},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":121073.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99588.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220042.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":237276.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":94846.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":239460.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17993.98,"maximum":58151.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43039.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31274.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39092.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39630.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34549.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26476.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23723.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17993.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29401.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24184.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53436.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18672.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57621.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58151.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20285.94,"10th_percentile":20285.94,"90th_percentile":20285.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42123.86,"maximum":136132.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":100754.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73214.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91514.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92775.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":80879.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":61982.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55537.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42123.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":68829.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125093.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43114.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":134890.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":53919.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136132.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":26381.59,"10th_percentile":26381.59,"90th_percentile":26381.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6160.78,"maximum":19909.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14735.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10707.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13384.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13568.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11828.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9065.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8122.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6160.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10066.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8280.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6558.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19728.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19909.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11986.39,"maximum":38736.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28669.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20833.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26040.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26399.36},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23014.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17637.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11986.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19585.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16110.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35595.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12284.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38383.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15342.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38736.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13519.48,"10th_percentile":13519.48,"90th_percentile":13519.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5285.53,"maximum":17081.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12642.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9186.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11482.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11641.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10148.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7777.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5285.53},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8636.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15696.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6107.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16925.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6765.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17081.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4386.06,"maximum":14174.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10490.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7623.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9528.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9660.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8421.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6453.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4386.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7166.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13025.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5215.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14045.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5614.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14174.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6325.53,"10th_percentile":6325.53,"90th_percentile":6325.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6357.82,"maximum":20546.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15207.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11050.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13812.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14002.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12207.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9355.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6357.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10388.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18880.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7126.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20359.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20546.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7167.19,"10th_percentile":7167.19,"90th_percentile":7167.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":10221.72,"10th_percentile":10221.72,"90th_percentile":10221.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4681.3,"maximum":15128.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11197.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8136.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10170.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10310.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8988.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6888.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6171.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4681.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7649.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6291.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13901.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5397.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14990.64},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5992.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15128.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7196.41,"maximum":23256.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17212.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12507.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15634.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15849.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13817.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10589.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7196.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11758.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9672.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21370.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8134.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23044.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23256.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11548.43,"maximum":37321.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27622.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20071.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25089.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25434.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22173.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16992.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11548.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18869.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15521.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34294.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13486.25},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36980.83},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14782.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37321.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4688.5,"maximum":15151.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11214.26},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8148.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10185.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10326.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9002.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6898.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4688.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7660.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6301.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13923.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5675.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15013.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15151.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6213.15,"maximum":20079.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14861.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10798.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13498.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13684.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11929.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9142.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6213.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10152.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8350.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18450.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7678.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19895.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20079.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12354.29,"maximum":39925.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29549.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21472.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26839.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27209.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23720.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18178.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16288.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12354.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20186.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16604.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36688.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12593.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39561.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39925.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14067.71,"10th_percentile":14067.71,"90th_percentile":14067.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4114.39,"maximum":13296.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9841.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7151.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8938.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9061.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7899.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6054.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4114.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6722.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5529.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12218.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5127.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13175.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5266.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13296.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5275.71,"maximum":17049.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12618.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9169.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11461.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11619.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10129.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7762.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5275.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8620.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7090.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15667.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6679.61},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16894.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6753.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17049.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6007.4,"10th_percentile":6007.4,"90th_percentile":6007.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8604.54,"maximum":27807.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20580.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14955.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18693.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18951.02},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16521.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12660.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8604.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14059.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11564.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25552.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10023.92},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27553.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11014.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27807.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5071.59,"10th_percentile":5071.59,"90th_percentile":5071.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4202.76,"maximum":13582.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10052.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7304.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9130.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9256.36},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8069.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6184.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4202.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6867.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5648.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12480.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5331.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13458.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5379.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13582.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5518.58,"maximum":17834.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13199.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9591.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11989.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12154.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10595.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8120.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5518.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9017.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6711.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17671.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7063.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17834.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6283.96,"10th_percentile":6283.96,"90th_percentile":6283.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6230.06,"10th_percentile":6230.06,"90th_percentile":6230.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":12413.55,"10th_percentile":12413.55,"90th_percentile":12413.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7251.4,"maximum":23434.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17344.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12603.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15753.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15970.82},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10669.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9560.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7251.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11848.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9746.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21534.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8599.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23220.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9281.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23434.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4785.65,"10th_percentile":4785.65,"90th_percentile":4785.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":7251.4,"10th_percentile":7251.4,"90th_percentile":7251.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8087.37,"maximum":26136.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19343.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14056.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17569.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17812.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15528.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11899.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10662.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8087.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13214.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10869.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24016.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9138.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25897.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26136.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":13214.65,"10th_percentile":13214.65,"90th_percentile":13214.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":21805.02,"10th_percentile":21805.02,"90th_percentile":21805.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9131.31,"10th_percentile":9131.31,"90th_percentile":9140.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4695.05,"maximum":15173.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11229.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8160.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10200.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10340.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9014.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6908.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6190.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4695.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7671.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6310.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13942.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5494.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15034.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6009.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15173.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6475.0,"maximum":20925.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15487.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11253.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14066.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14260.84},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12432.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9527.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6475.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10580.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8702.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19228.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7726.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20734.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20925.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7311.24,"10th_percentile":7311.24,"90th_percentile":7311.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10202.5,"maximum":32971.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24402.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17732.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22164.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22470.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19589.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15012.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10202.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16670.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13712.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30297.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11597.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32670.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32971.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11501.31,"10th_percentile":11501.31,"90th_percentile":11501.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5148.71,"maximum":16639.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12315.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8948.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11185.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11339.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9885.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7575.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5148.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8412.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15289.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5517.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16487.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16639.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6965.98,"maximum":22512.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16661.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12107.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15342.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13374.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10249.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6965.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11382.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9362.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20686.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7653.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22306.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8916.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22512.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10015.28,"maximum":32366.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23955.17},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17407.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21758.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22058.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19229.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14736.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10015.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16364.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29741.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11344.66},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32071.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32366.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4934.65,"maximum":15947.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11803.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8576.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10720.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10868.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9474.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7260.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4934.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8063.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6632.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14654.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6335.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15801.91},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15947.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7011.15,"maximum":22658.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16769.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12185.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15231.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15441.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13461.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10316.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7011.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11456.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9423.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20820.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8659.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22451.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8974.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22658.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11560.87,"maximum":37361.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27652.03},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20093.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25116.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25462.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22197.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17011.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15242.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11560.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18890.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15538.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34331.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12966.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37020.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37361.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13048.36,"10th_percentile":13048.36,"90th_percentile":13048.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4942.5,"maximum":15972.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11821.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8590.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10737.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10885.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7272.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6516.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4942.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8075.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14677.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6510.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15827.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15972.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6389.25,"maximum":20648.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15282.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11104.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13880.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14071.97},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12267.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9401.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6389.25},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10439.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18973.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9345.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20459.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8178.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20648.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10230.0,"maximum":33060.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24468.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17780.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22224.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22531.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19642.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15052.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13487.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10230.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16715.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13749.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30379.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14216.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32758.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33060.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7870.71,"10th_percentile":7870.71,"90th_percentile":7870.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":11828.08,"10th_percentile":11828.08,"90th_percentile":11828.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5269.82,"maximum":17030.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12604.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9159.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11448.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11606.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10118.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7754.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5269.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8610.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15649.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6377.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16875.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17030.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8992.08,"maximum":29059.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21507.83},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15628.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19535.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19804.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17265.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13231.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8992.08},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14692.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12085.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26703.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10857.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28794.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11510.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29059.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10642.66,"10th_percentile":10642.66,"90th_percentile":10642.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":21538.5,"10th_percentile":21538.5,"90th_percentile":21538.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10145.74,"10th_percentile":10145.74,"90th_percentile":10145.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19484.59,"maximum":62968.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46604.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33865.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42330.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42913.74},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37411.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28670.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25689.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19484.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31837.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26187.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57862.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62394.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24940.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62968.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22417.79,"10th_percentile":22417.79,"90th_percentile":22417.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":28670.17,"10th_percentile":28670.17,"90th_percentile":28670.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8944.95,"maximum":28907.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21395.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15546.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19432.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19700.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13161.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11793.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8944.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14615.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26563.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9972.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28643.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28907.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11805.71,"maximum":38152.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28237.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20519.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25647.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26001.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22667.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17371.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11805.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19290.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15867.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35058.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14390.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37804.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38152.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10185.51,"10th_percentile":10185.51,"90th_percentile":10185.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13323.01,"10th_percentile":13323.01,"90th_percentile":13323.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24468.33,"maximum":79074.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58524.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42527.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53157.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53890.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":36003.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32259.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24468.33},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39980.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72662.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28043.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78353.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31320.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79074.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":32463.56,"10th_percentile":32463.56,"90th_percentile":32463.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13051.36,"10th_percentile":13051.36,"90th_percentile":13051.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12531.04,"maximum":40496.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29972.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21779.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27223.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27598.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24060.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18438.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16521.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12531.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20475.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16842.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37212.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13900.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40127.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16040.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40496.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14133.48,"10th_percentile":14133.48,"90th_percentile":14133.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16523.01,"maximum":53397.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39520.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28718.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35896.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36391.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31724.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24312.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21784.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16523.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26998.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22207.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49067.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19030.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52910.61},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53397.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18814.58,"10th_percentile":18814.58,"90th_percentile":18814.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18640.83,"10th_percentile":18640.83,"90th_percentile":18648.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29339.48,"maximum":94816.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":70176.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50993.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63740.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64618.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":56332.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43170.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38681.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29339.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":47940.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39433.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36635.6},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93951.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":37555.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94816.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":43170.94,"10th_percentile":43170.94,"90th_percentile":43170.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33098.42,"10th_percentile":33098.42,"90th_percentile":33098.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":38968.62,"10th_percentile":38968.62,"90th_percentile":38968.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4638.1,"maximum":14989.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11093.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8061.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10076.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10215.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8905.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6824.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4638.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7578.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13773.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5058.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14852.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14989.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5955.88,"maximum":19247.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14245.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10351.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12939.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13117.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11435.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8763.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7852.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5955.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9731.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17686.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6514.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19072.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7623.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19247.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11238.79,"maximum":36320.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26881.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19533.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24416.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24752.82},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21578.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16537.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14817.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11238.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18364.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33375.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11748.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35989.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36320.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4524.19,"maximum":14620.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10821.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7863.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9828.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9964.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8686.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6657.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5964.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4524.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7392.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13435.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4919.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14487.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14620.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5999.74,"maximum":19389.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14350.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10427.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13034.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13214.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11519.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8828.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7910.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5999.74},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9803.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17817.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6773.57},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19212.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19389.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10235.23,"maximum":33077.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24481.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17789.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22236.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22542.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19652.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15060.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10235.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16724.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13756.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30395.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10801.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32775.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13101.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33077.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5241.02,"maximum":16937.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12535.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9109.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11386.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11543.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10062.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7711.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5241.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8563.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15564.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5948.95},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16782.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6708.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16937.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9038.56,"maximum":29210.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21619.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15709.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19636.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19906.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13299.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9038.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14768.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12148.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26841.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9969.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28943.61},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11569.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29210.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5595.83,"maximum":18084.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13384.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9725.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12156.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12324.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10744.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8233.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5595.83},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9143.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16617.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6541.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17919.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7162.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18084.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10358.31,"maximum":33475.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24775.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18003.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22503.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22813.6},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19888.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15241.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10358.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16925.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30760.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12104.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33169.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13258.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33475.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6391.21,"maximum":20654.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15286.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11108.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13884.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14076.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12271.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9404.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6391.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10443.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18979.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7405.75},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20466.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20654.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4460.04,"maximum":14413.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10667.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7751.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9689.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9822.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8563.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6562.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5880.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4460.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7287.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13244.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5267.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14282.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5708.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14413.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9667.66,"maximum":31243.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23123.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16803.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21003.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21292.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18562.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14225.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9667.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15796.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11464.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30958.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12374.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31243.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5170.32,"maximum":16709.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12366.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8986.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11232.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11387.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9927.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7607.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5170.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8448.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6949.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15354.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6312.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16556.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16709.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5834.47,"10th_percentile":5834.47,"90th_percentile":5834.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6242.34,"10th_percentile":6242.34,"90th_percentile":6242.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3561.22,"maximum":11508.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8517.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6189.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7736.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7843.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":6837.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5240.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4695.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3561.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":5818.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4786.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4356.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11403.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11508.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":5240.08,"10th_percentile":5240.08,"90th_percentile":5240.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":49326.52,"10th_percentile":49326.52,"90th_percentile":49326.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8302.75,"maximum":26832.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19859.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14430.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18037.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18286.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15941.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12216.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10946.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8302.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13566.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24656.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9283.5},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26587.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26832.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9583.73,"10th_percentile":9583.73,"90th_percentile":9583.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5103.54,"maximum":16493.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12206.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8870.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11087.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11240.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9799.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7509.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6728.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5103.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8339.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15155.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5724.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16342.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16493.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":10325.92,"10th_percentile":10325.92,"90th_percentile":10325.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":1381.66,"10th_percentile":1381.66,"90th_percentile":1381.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10469.59,"maximum":33834.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25041.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18196.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22745.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23058.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20102.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15405.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13803.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10469.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17107.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14071.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31091.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12211.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33526.13},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13401.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33834.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":14333.98,"10th_percentile":14333.98,"90th_percentile":14333.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6125.43,"maximum":19795.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14651.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10646.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13307.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13490.92},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11761.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9013.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8075.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6125.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10008.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18190.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7051.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19615.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19795.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6919.62,"10th_percentile":6919.62,"90th_percentile":6919.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":19795.67,"10th_percentile":19795.67,"90th_percentile":19795.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4248.59,"maximum":13730.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10162.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7384.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9230.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9357.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8157.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6251.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4248.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6942.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5710.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12616.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4919.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13604.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5438.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13730.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":6319.47,"10th_percentile":6319.47,"90th_percentile":6319.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4999.14,"10th_percentile":4999.14,"90th_percentile":4999.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15677.88,"maximum":50666.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37499.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27249.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34060.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34529.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30102.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23068.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15677.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25617.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21071.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46557.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50204.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50666.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9908.57,"maximum":32021.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23699.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17221.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21526.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21823.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19024.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14579.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9908.57},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16190.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29425.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31729.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32021.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7493.62,"maximum":24217.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17923.71},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13024.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16279.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16504.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14388.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11026.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7493.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12244.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22253.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23996.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24217.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26319.64,"maximum":85057.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62952.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45745.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57179.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57967.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":50534.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":38727.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34700.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26319.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":43005.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35374.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78160.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84281.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":33689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85057.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35811.86,"maximum":115733.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":85657.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62243.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77801.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78873.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":68760.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":52694.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47215.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35811.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":58516.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106349.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":40796.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114678.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":45840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115733.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18985.75,"maximum":61356.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45411.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32998.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41246.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41815.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36453.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27936.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25031.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18985.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31022.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25517.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56381.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20979.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60796.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24302.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61356.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14530.3,"maximum":46957.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34754.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25254.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31567.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32002.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27898.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21380.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14530.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23742.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19529.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43150.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15682.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46529.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18599.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46957.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23341.7,"maximum":75433.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55830.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40569.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50709.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51408.82},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44816.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34345.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30774.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23341.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38140.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31371.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69316.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26787.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74745.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75433.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14253.39,"maximum":46062.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34092.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24773.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30965.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31392.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20972.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14253.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23289.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19156.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42327.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17994.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45642.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46062.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10393.66,"maximum":33589.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24860.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18064.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22580.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22891.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19956.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15293.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13703.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10393.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16983.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30865.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12478.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33282.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13304.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33589.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21624.59,"maximum":69884.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51723.07},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37584.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46979.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47626.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":41520.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31819.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28510.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21624.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":35334.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29064.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64217.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28793.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69247.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69884.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13763.72,"maximum":44480.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32920.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23922.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29901.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30313.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26426.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20252.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18146.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13763.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22489.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18498.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40873.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17867.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44074.71},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44480.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10870.23,"maximum":35129.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26000.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18893.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23615.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23941.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20871.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15994.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14331.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10870.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17761.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12157.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34809.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13914.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35129.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6319.2,"maximum":20421.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15114.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10983.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13728.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13917.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12133.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9298.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8331.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6319.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10325.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18765.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7016.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20235.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20421.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4580.49,"maximum":14802.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10955.9},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7961.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9951.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10088.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6739.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6039.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4580.49},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7484.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6156.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13602.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5113.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14667.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5863.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14802.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10938.31,"maximum":35349.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26162.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19011.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23763.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24091.04},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21002.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16094.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10938.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17873.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14701.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32483.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12223.39},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35027.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35349.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7164.34,"maximum":23153.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17136.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12452.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15564.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15779.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13755.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10541.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9445.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7164.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11706.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9629.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21275.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8077.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22941.91},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9170.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23153.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5415.8,"maximum":17502.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12953.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9413.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11765.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11928.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10398.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7968.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7140.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5415.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8849.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16083.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6109.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17342.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6932.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17502.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43740.16,"maximum":141355.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":104620.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76023.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95025.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96335.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":83982.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":64360.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57668.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43740.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":71470.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58787.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129893.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":140066.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":55988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141355.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27761.8,"maximum":89718.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66402.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48251.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60312.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61143.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":53303.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40849.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27761.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45362.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37312.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88899.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89718.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34889.48,"maximum":112753.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":83450.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60640.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75797.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76842.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":66989.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":51337.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45999.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34889.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":57008.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46892.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103609.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":111724.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":44659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112753.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21147.36,"maximum":68342.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50581.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36755.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45942.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46575.91},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40603.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31116.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27881.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21147.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34554.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28422.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62800.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67718.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68342.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55011.68,"maximum":177782.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":131580.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95613.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119513.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121160.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":105624.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":80945.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72528.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":55011.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":89888.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73937.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":68263.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":176160.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":70416.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177782.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39036.6,"maximum":126155.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":93370.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67848.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84807.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85975.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":74951.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":57439.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51466.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39036.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":63785.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115925.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":48960.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":125004.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":49967.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126155.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27315.34,"maximum":88275.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65334.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47475.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59342.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60160.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52446.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40192.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36013.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27315.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44632.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81117.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35284.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87470.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":34964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88275.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36155.55,"maximum":116844.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":86479.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62840.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78548.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79630.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":69420.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":53200.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47668.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36155.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":59077.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48594.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107369.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":40432.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":115778.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":46280.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116844.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17413.32,"maximum":56274.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41650.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30265.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37830.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38351.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":33434.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":25622.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22958.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17413.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28453.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23403.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51711.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23576.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55761.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56274.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37310.98,"maximum":120578.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":89242.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64848.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81058.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82175.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":71638.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":54900.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49191.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37310.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":60965.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50146.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110800.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39297.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":119478.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":47759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120578.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20389.95,"maximum":65894.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48769.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35439.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44297.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44907.74},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39149.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30002.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26882.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20389.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33316.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27404.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60551.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22195.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65293.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26099.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65894.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11938.6,"maximum":38582.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28555.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20750.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25936.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26294.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22922.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17566.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11938.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19507.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16045.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35453.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14396.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38230.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38582.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34076.42,"maximum":110125.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":81506.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59227.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74031.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75051.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":65428.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":50141.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44927.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34076.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":55680.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45799.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101195.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38329.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":109120.8},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":43618.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110125.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23086.39,"maximum":74608.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55219.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40125.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50155.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50846.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44326.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33969.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30437.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23086.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":37722.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31028.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68558.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26400.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73928.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29551.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74608.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17989.4,"maximum":58136.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43028.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31266.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39082.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39620.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34540.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26470.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23717.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17989.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29394.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24178.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53422.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21138.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57606.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58136.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19856.42,"maximum":64170.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47493.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34511.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43138.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43732.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":38125.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29217.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19856.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32445.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58966.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23602.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63584.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64170.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12627.27,"maximum":40807.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30202.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21947.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27432.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27810.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24244.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18580.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16648.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12627.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20632.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14796.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40435.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40807.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31610.41,"maximum":102155.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":75607.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54940.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68673.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69620.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":60693.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":46512.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41676.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31610.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":51650.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42485.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93872.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37542.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":101224.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":40462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102155.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19286.23,"maximum":62327.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46130.03},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33520.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41899.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42476.87},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37030.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28378.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25427.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19286.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31513.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25921.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57273.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22862.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61759.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24686.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62327.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22198.81,"10th_percentile":22198.81,"90th_percentile":22198.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":54957.21,"10th_percentile":54957.21,"90th_percentile":54957.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15981.63,"maximum":51648.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38225.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27777.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34720.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35198.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30685.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23515.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21070.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15981.63},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26113.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47460.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18885.71},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51176.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51648.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28102.87,"maximum":90820.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67218.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48844.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61053.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61895.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":53958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":41351.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37051.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28102.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45919.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37771.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83455.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29127.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89992.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35972.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90820.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14897.55,"maximum":48144.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35632.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25892.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32365.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32811.04},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28603.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21920.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19641.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14897.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24342.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20022.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44240.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15793.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47705.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48144.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12088.84,"maximum":40566.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30024.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21817.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27270.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27646.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24101.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18470.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12552.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20510.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16871.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37277.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12088.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40196.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40566.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6747.99,"maximum":21807.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16140.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11728.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14660.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14862.07},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12956.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9929.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8896.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6747.99},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11026.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9069.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20039.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7427.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21608.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21807.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7683.86,"10th_percentile":7683.86,"90th_percentile":7683.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":33922.9,"10th_percentile":33922.9,"90th_percentile":33922.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7614.22,"10th_percentile":7614.22,"90th_percentile":7614.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9056.16,"10th_percentile":9056.16,"90th_percentile":9056.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10502.33,"maximum":33940.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25120.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18253.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22816.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23130.8},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15453.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10502.33},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17160.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14115.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31188.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10641.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33630.94},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33940.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4950.36,"maximum":15998.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11840.58},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8604.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10754.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10902.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9504.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7284.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4950.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8088.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14700.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5551.3},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15852.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6336.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15998.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6716.57,"maximum":21706.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16065.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11673.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14591.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14792.87},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12896.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9882.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6716.57},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10974.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9027.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7477.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21508.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21706.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10898.38,"maximum":35220.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26067.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18942.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23676.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24003.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20925.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16036.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14368.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10898.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17807.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14647.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32364.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12575.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34899.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13950.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35220.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5229.23,"maximum":16899.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12507.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9088.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11360.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11517.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10040.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7694.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5229.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8544.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15529.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5865.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16745.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16899.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5954.46,"10th_percentile":5954.46,"90th_percentile":5954.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5916.76,"10th_percentile":5916.76,"90th_percentile":5916.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5658.67,"maximum":18287.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13534.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9835.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12293.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12462.92},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10864.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8326.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5658.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9246.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16804.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6790.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18120.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7243.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18287.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9614.64,"maximum":31071.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22996.9},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16710.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20887.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21175.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18460.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14147.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9614.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15710.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28552.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11008.65},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30788.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31071.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4480.33,"maximum":14479.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10716.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7787.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9733.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9867.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8602.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6592.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5906.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4480.33},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7320.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6021.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13305.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5389.69},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14347.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5734.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14479.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6613.79,"maximum":21373.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15819.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11495.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14368.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14566.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9731.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8719.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6613.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10806.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19640.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7725.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21178.92},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21373.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33276.23,"10th_percentile":33276.23,"90th_percentile":33276.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7632.86,"10th_percentile":7632.86,"90th_percentile":7639.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9731.71,"10th_percentile":9731.71,"90th_percentile":9731.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":16334.31,"10th_percentile":16334.31,"90th_percentile":16334.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7459.33,"10th_percentile":5066.64,"90th_percentile":7475.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":12100.0,"10th_percentile":12100.0,"90th_percentile":12100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13164.73,"maximum":42544.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31488.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22881.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28600.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28994.6},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19370.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17356.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13164.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21510.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17693.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39094.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14092.87},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42156.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42544.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":33722.31,"10th_percentile":33722.31,"90th_percentile":33722.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14848.61,"10th_percentile":14848.61,"90th_percentile":14848.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":15989.03,"10th_percentile":15989.03,"90th_percentile":15989.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9189.78,"maximum":29698.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21980.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15972.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19964.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20239.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17644.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13522.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9189.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15015.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12351.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27290.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12634.57},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29427.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29698.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":1328.32,"10th_percentile":1328.32,"90th_percentile":1328.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11503.26,"maximum":37175.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27514.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19993.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24990.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25335.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22086.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16926.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11503.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18796.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15460.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34160.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15118.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36836.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14724.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37175.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13098.64,"10th_percentile":13098.64,"90th_percentile":13098.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":31765.45,"10th_percentile":31765.45,"90th_percentile":31765.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18048.97,"maximum":58329.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43170.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31370.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39211.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39751.87},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34654.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26557.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23796.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18048.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29491.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53599.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20998.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57797.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58329.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6021.34,"maximum":19459.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14402.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10465.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13081.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13261.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11561.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8859.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7938.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6021.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9838.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17881.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6627.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19281.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19459.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8123.38,"maximum":26252.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19430.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14118.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17648.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17891.3},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15597.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11952.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10710.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8123.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13273.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24123.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8197.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26012.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10398.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26252.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11191.0,"maximum":36166.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26767.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19450.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24312.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24647.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21487.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16466.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14754.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11191.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18285.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33233.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14693.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35836.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36166.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8481.46,"maximum":27409.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20286.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14741.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18426.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18679.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16284.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12479.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11182.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8481.46},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13858.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25187.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9101.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27159.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10856.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27409.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":19888.76,"10th_percentile":19888.76,"90th_percentile":19888.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46712.57,"10th_percentile":46712.57,"90th_percentile":46712.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":33303.48,"10th_percentile":33303.48,"90th_percentile":33303.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62344.42,"10th_percentile":62344.42,"90th_percentile":62344.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32943.47,"10th_percentile":32943.47,"90th_percentile":32943.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":81033.08,"10th_percentile":81033.08,"90th_percentile":81033.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15207.85,"maximum":49147.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36375.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26432.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33039.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33494.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29199.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22377.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20050.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15207.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24849.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20439.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45162.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16480.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48699.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19466.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49147.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25800.24,"10th_percentile":25800.24,"90th_percentile":25800.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6674.67,"maximum":21570.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15964.9},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11601.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14500.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14700.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12815.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9821.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6674.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10906.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7411.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21373.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8543.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21570.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6588.43,"10th_percentile":6588.43,"90th_percentile":6588.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9995.64,"maximum":32303.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23908.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17373.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21715.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22014.84},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19192.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14707.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13178.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9995.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16332.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13434.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29683.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10073.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32008.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12794.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32303.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11289.96,"10th_percentile":11289.96,"90th_percentile":11289.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6410.2,"maximum":20715.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15332.31},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11141.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13926.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14118.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12307.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9432.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6410.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10474.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19036.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7262.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20526.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20715.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11857.42,"maximum":38319.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28361.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20608.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25760.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26115.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22766.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17447.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11857.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19374.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15936.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35212.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12244.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37970.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38319.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11310.15,"maximum":36551.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27052.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19657.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24571.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24909.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21715.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16642.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11310.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18480.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15201.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33587.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13893.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36217.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36551.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14393.48,"maximum":46515.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34427.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25016.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31269.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31700.86},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27636.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21178.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14393.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23518.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19345.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42743.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17826.57},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46091.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46515.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25276.81,"maximum":81687.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60458.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43932.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54913.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55670.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":48532.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":37193.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33325.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25276.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41301.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33972.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75063.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29619.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80942.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32354.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81687.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7695.25,"maximum":24868.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18405.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13374.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16717.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16948.36},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11323.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7695.25},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12573.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22852.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8503.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24642.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9850.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24868.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8762.5,"10th_percentile":8762.5,"90th_percentile":8762.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8740.71,"10th_percentile":8740.71,"90th_percentile":8740.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":10364.46,"10th_percentile":10364.46,"90th_percentile":11509.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":10957.0,"10th_percentile":10957.0,"90th_percentile":10957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":24868.88,"10th_percentile":24868.88,"90th_percentile":24868.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10622.12,"maximum":34327.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25406.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18461.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23076.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23394.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20394.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15629.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14004.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10622.12},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17356.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14276.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12592.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34014.56},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34327.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12226.4,"10th_percentile":12226.4,"90th_percentile":12226.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":11509.42,"10th_percentile":11509.42,"90th_percentile":11509.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11852.5,"10th_percentile":11852.5,"90th_percentile":11852.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":35028.69,"10th_percentile":35028.69,"90th_percentile":35028.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21551.27,"maximum":69647.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51547.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37457.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46820.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47465.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":41379.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31711.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28413.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21551.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":35214.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28965.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63999.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24379.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69012.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27586.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69647.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24540.2,"10th_percentile":24540.2,"90th_percentile":24540.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12718.27,"maximum":41101.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30420.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22105.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27630.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28011.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24419.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18714.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16768.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12718.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20781.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17093.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13162.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40726.92},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41101.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15649.07,"maximum":50573.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37430.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27199.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33997.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34466.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30046.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23026.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20632.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15649.07},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25570.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21032.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46472.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17305.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50112.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20031.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50573.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25339.0,"maximum":81888.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60607.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44040.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55049.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55807.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":48651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":37284.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33407.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25339.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41403.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34056.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75248.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28216.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81141.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81888.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10885.94,"maximum":35180.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26037.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18920.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23649.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23975.69},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20901.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16017.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10885.94},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17787.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14631.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32327.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12785.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34859.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13934.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35180.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13950.29,"maximum":45083.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33367.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24246.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30307.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30724.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26785.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20526.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13950.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22794.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41427.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16478.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44672.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17856.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45083.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29330.97,"maximum":94789.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":70155.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50979.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63721.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64599.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":56316.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43158.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38670.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29330.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":47926.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39421.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32883.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93924.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":37544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94789.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14370.57,"maximum":46441.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34372.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24976.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31220.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31650.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27592.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21145.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18946.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14370.57},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23481.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19314.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42675.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17079.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46017.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18394.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46441.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22333.56,"maximum":72175.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53418.83},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38817.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48519.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49188.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":42881.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":32862.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29445.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22333.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":36492.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30016.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66323.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24107.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71517.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":28587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72175.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39332.49,"maximum":127111.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":94077.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68362.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85450.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86627.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":75519.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":57874.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51857.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39332.49},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":64268.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52863.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116804.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42023.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":125951.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":50346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127111.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16515.81,"maximum":53374.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39503.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28705.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35880.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36375.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31711.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24301.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16515.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26986.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49046.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18015.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52887.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53374.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20353.94,"maximum":65778.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48683.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35376.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44219.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44828.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39080.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29949.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26835.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20353.94},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33258.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27356.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22895.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65178.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26053.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65778.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29764.34,"maximum":96189.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71192.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51732.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64663.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65554.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":57148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43796.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29764.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":48634.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40004.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":33033.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95312.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96189.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15888.73,"10th_percentile":15888.73,"90th_percentile":15888.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33572.18,"10th_percentile":33572.18,"90th_percentile":33572.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25608.71,"maximum":82760.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61252.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44509.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55635.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56401.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":49169.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":37681.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33763.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25608.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41844.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76049.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30192.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82005.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82760.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37512.61,"maximum":121230.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":89725.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65199.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81496.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82619.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":72025.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":55197.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49457.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37512.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":61295.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50417.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111399.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42223.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":120124.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":48017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121230.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20800.4,"maximum":67221.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49751.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36152.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45188.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45811.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39937.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30606.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20800.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33987.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27956.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61770.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37072.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66607.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26625.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67221.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34655.12,"maximum":111995.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":82890.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60232.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75288.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76326.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":66539.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":50992.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45690.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34655.12},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":56625.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46577.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102913.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":62193.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":110973.93},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":44359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111995.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51512.0,"maximum":166472.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":123209.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89531.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111910.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113452.36},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":98905.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":75796.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67914.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":51512.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":84169.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69233.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152973.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":81341.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":164953.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":65936.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166472.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46705.66,"maximum":150939.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":111713.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81177.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101468.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":102866.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":89676.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":68724.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61578.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46705.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":76316.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62773.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138699.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":149562.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":59784.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150939.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":282690.15,"maximum":913575.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":676156.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491333.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614145.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":622609.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":542776.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":415958.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":372706.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":282690.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":461911.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":379943.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":839494.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":905241.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":361850.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":913575.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33431.11,"maximum":114925.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":85058.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61808.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77258.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78322.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":68280.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":52326.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46885.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35561.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":58107.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47796.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":33431.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113877.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":45520.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114925.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38817.95,"maximum":125448.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":92847.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67468.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84332.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85494.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":74532.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":57117.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51178.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38817.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":63427.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52172.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":51756.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":124304.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":49688.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125448.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78673.5,"maximum":254250.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":188176.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":136739.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170918.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":173274.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":151056.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":115762.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103725.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":78673.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":128551.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105739.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233633.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":95877.83},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":251931.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":100704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":254250.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18230.98,"maximum":60967.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45123.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32789.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40984.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41549.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36222.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27758.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24872.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18865.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30825.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25355.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56023.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18230.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60411.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24148.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60967.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27599.45,"maximum":89193.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66014.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47969.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59959.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60786.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52992.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40610.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36387.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27599.45},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45097.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37094.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28369.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88380.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35328.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89193.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35704.5,"maximum":115386.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":85400.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62056.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77568.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78637.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":68554.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":52536.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47073.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35704.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":58340.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47987.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37162.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114334.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":45702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115386.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29888.34,"maximum":151809.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":112357.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81645.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102052.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103459.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":90193.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":69119.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61932.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46974.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":76756.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63135.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139499.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29888.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":150424.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":60128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151809.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36689.73,"maximum":118570.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":87756.83},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63769.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79708.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80807.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":70445.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":53986.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48372.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36689.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":59950.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49312.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108956.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42216.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117489.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":46963.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118570.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81080.62,"maximum":273974.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":202774.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":147347.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184177.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":186715.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":162774.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":124742.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111771.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":84776.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":138523.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113942.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251758.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":81080.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":271475.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":108516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273974.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30355.47,"maximum":98100.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72606.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52759.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65947.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66856.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":58283.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":44665.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40021.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30355.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":49600.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40798.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90145.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36622.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97205.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98100.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67496.24,"maximum":218128.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":161441.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":117312.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146635.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":148656.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":129595.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":99315.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88988.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":67496.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":110287.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90716.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200440.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":77520.57},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":216139.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":86396.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218128.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86774.74,"maximum":293040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":216885.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":157601.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":196994.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":199709.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":174102.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":133423.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119550.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":90676.25},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":148163.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121871.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":269277.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":86774.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":290366.9},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":116068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":293040.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":138947.8,"maximum":449040.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":332344.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":241500.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":301864.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":306024.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":266785.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":204451.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":138947.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":227038.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186749.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":412627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":142476.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":444943.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":177856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":449040.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1875.0,"10th_percentile":1875.0,"90th_percentile":1875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74182.04,"maximum":239735.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":177433.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128933.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161160.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":163381.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":142432.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":109153.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":74182.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":121212.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99702.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":105340.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":237548.52},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":94954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":239735.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":183454.54,"maximum":592873.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":438798.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":318855.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398555.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":404048.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":352239.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":269940.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241871.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":183454.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":299762.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246567.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":544797.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":207724.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":587465.02},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":234826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":592873.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5933.62,"maximum":19175.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14192.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10313.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12890.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13068.48},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11392.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8730.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5933.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9695.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17620.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6209.79},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19000.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7595.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19175.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14348.31,"maximum":46369.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34319.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24938.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31171.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31601.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27549.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21112.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14348.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23444.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18291.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45946.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46369.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9160.32,"maximum":29603.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21910.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15921.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19900.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20175.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17588.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13478.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9160.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14967.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12311.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27203.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11155.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29333.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11725.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29603.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22829.78,"maximum":73779.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54605.71},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39679.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49597.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50281.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43834.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33592.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30099.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22829.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":37303.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30683.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67796.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30074.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73106.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73779.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12243.66,"maximum":39568.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29285.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21280.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26599.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26965.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23508.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18015.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12243.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20005.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36359.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15419.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39207.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15672.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39568.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9958.58,"10th_percentile":9958.58,"90th_percentile":9958.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9869.79,"10th_percentile":9869.79,"90th_percentile":9869.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":15541.66,"10th_percentile":15541.66,"90th_percentile":15541.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9284.7,"maximum":30005.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22207.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16137.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20171.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20449.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17826.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13661.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9284.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15171.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12478.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27572.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9430.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29731.82},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11884.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30005.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18901.96,"maximum":61085.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45210.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32852.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41064.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41630.53},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36292.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27812.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24920.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18901.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30885.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56132.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23141.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60528.57},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61085.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10476.14,"maximum":33855.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25057.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18208.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22759.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23073.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20114.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15414.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13812.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10476.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17117.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14080.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31110.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13490.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33547.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33855.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9892.19,"10th_percentile":9892.19,"90th_percentile":9892.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9874.53,"maximum":31911.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23618.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17162.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21452.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21748.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18959.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14529.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13018.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9874.53},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16134.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13271.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11816.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31620.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31911.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":23155.45,"10th_percentile":23155.45,"90th_percentile":23155.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11135.33,"10th_percentile":11135.33,"90th_percentile":11135.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23299.8,"maximum":75298.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55729.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40496.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50618.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51316.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44736.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34283.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30719.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23299.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38071.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69192.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28380.43},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74611.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29824.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75298.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11743.52,"maximum":37951.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28088.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20410.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25512.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25864.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22548.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17279.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15482.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11743.52},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19188.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34874.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14677.69},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37605.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37951.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8195.39,"maximum":26485.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19602.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14244.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17804.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18049.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15735.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12058.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10805.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8195.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13391.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11014.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24337.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8283.73},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26243.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26485.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19770.66,"maximum":63893.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47288.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34362.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42951.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43543.8},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37960.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29091.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26066.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19770.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32304.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26572.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58712.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21987.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63310.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25306.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63893.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9815.61,"maximum":31721.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23477.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17060.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21324.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21618.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18846.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14442.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12941.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9815.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16038.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13192.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29149.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12649.61},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31431.92},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12564.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31721.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8582.16,"maximum":28101.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20798.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15113.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18891.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19151.43},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16695.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12794.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8695.53},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14208.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25822.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8582.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27845.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28101.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24396.97,"maximum":78844.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58354.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42403.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53002.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53733.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46843.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":35898.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32165.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24396.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39864.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32790.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72450.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27732.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78124.91},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78844.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14263.21,"maximum":46094.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34115.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24790.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30986.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31413.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27385.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20987.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18805.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14263.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23305.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19170.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42356.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17460.49},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45674.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46094.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9554.41,"maximum":30877.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22852.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16606.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20757.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21043.07},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14058.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9554.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15611.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28373.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10890.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30595.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12229.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30877.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9405.16,"maximum":30394.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22495.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16346.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20432.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20714.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18058.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13839.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9405.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15367.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12640.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27930.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10416.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30117.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30394.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10854.35,"10th_percentile":10854.35,"90th_percentile":10854.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":10875.95,"10th_percentile":10875.95,"90th_percentile":10875.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5866.85,"maximum":18960.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14032.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10196.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12745.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12921.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11264.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8632.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7735.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5866.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9586.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17422.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6645.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18787.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18960.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6680.53,"10th_percentile":6680.53,"90th_percentile":6680.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4066.6,"maximum":13142.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9726.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7068.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8834.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8956.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7808.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5983.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4066.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6644.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5465.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12076.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4609.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13022.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13142.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8743.32,"maximum":28255.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20912.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15196.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18994.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19256.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12865.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11527.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8743.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14286.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11751.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25964.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9127.14},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27998.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28255.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10049.51,"10th_percentile":10049.51,"90th_percentile":10049.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5094.38,"maximum":16463.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12185.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8854.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11067.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11220.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9781.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7496.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5094.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8324.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6846.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5687.36},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16313.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16463.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5756.4,"10th_percentile":5756.4,"90th_percentile":5756.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9139.17,"maximum":30085.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22267.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16180.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20225.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20503.84},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17874.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13698.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9309.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15211.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27646.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9139.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29811.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11916.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30085.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10775.96,"maximum":34824.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25774.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18729.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23410.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23733.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20690.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15856.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10775.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17607.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14483.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32000.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12218.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34507.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34824.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6710.02,"maximum":21684.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16049.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11662.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14577.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14778.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12883.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9873.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8846.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6710.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10964.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9018.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19926.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7728.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21487.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8589.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21684.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6654.78,"10th_percentile":6654.78,"90th_percentile":6654.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5029.57,"maximum":16254.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12030.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8741.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10926.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11077.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9656.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7400.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6631.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5029.57},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8218.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6759.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14936.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5752.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16105.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6437.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16254.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8832.35,"maximum":28543.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21125.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15351.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19188.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19452.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16958.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12996.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11644.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8832.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14431.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26229.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10062.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28283.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11305.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28543.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11825.34,"maximum":38216.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28284.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20553.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25690.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26044.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17400.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11825.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19322.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35117.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15785.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37867.56},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15136.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38216.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9913.81,"maximum":32038.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23712.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17230.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21537.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21834.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19034.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14587.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13070.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9913.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16199.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29440.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11714.49},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31746.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12689.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32038.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19773.28,"maximum":63901.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47294.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34367.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42957.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43549.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37965.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29094.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26069.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19773.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32309.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26575.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58719.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20957.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63318.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63901.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13612.5,"maximum":43991.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32559.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23659.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29573.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29980.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26136.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20029.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13612.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22242.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40424.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14163.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43590.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43991.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10836.84,"maximum":35021.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25920.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18835.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23543.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23867.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20807.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15945.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10836.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17707.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14565.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32181.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11379.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34702.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35021.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10305.93,"maximum":33305.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24650.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17912.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22389.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22698.26},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19787.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15164.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13587.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10305.93},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16839.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13851.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30605.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11855.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33002.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13191.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33305.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6692.34,"maximum":21627.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16007.17},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11631.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14539.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14739.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12849.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9847.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6692.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10935.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8994.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19874.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8019.14},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21430.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21627.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20862.59,"maximum":67422.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49900.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36260.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45324.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45948.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40057.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30697.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20862.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34089.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28039.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61954.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23708.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66806.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26704.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67422.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13603.99,"maximum":43964.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32538.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23644.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29554.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29962.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26120.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20017.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17935.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13603.99},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22228.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18284.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40399.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14576.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43563.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43964.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":23217.69,"10th_percentile":23217.69,"90th_percentile":23217.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10059.79,"maximum":32510.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24061.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21854.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22156.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19315.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14802.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10059.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16437.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29874.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10638.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32213.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12876.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32510.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11454.99,"10th_percentile":11454.99,"90th_percentile":11454.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24465.71,"maximum":79066.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58518.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42523.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53151.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53884.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46975.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":35999.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32256.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24465.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39976.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32882.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72654.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25622.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78345.02},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79066.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13094.03,"maximum":42316.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31319.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22758.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28446.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28838.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25141.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19266.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13094.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21395.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17598.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38884.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14347.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41930.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42316.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9779.61,"maximum":31604.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23391.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16997.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21246.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21539.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18777.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14389.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12893.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9779.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15979.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29042.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10057.75},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31316.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12518.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31604.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":15979.74,"10th_percentile":15979.74,"90th_percentile":15979.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18789.36,"maximum":60721.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44941.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32657.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40819.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41382.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36076.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27647.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18789.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30701.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25253.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55798.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60168.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24050.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60721.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19436.48,"10th_percentile":19436.48,"90th_percentile":19436.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13863.23,"maximum":44802.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33158.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24095.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30117.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30533.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26617.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20398.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13863.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22652.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18632.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41169.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44393.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17745.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44802.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15638.86,"10th_percentile":15638.86,"90th_percentile":15638.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10262.73,"maximum":33166.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24547.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17837.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22295.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22603.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19704.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15100.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10262.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16769.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30476.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10970.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32863.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13136.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33166.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5277.02,"maximum":17053.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12621.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9171.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11464.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11622.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10132.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7764.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6957.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5277.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8622.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7092.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15670.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5846.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16898.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17053.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8392.43,"maximum":27121.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20073.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14586.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18232.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18483.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16113.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12348.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8392.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13713.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11279.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9224.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26874.57},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10742.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27121.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5286.84,"maximum":17085.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12645.4},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9188.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11485.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11643.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10150.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7779.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5286.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8638.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7105.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15700.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5701.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16929.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17085.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6076.66,"10th_percentile":6076.66,"90th_percentile":6076.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6247.19,"maximum":20189.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14942.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10858.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13572.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13759.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11994.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9192.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6247.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10207.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18552.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6847.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20004.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20189.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4715.34,"maximum":15238.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11278.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8195.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10244.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10385.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9053.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6938.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4715.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7704.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6337.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14002.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5419.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15099.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15238.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12894.37,"maximum":41670.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30841.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22411.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28013.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28399.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24757.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18973.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12894.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21069.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17330.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38291.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14171.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41290.82},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41670.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8486.05,"maximum":27424.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20297.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14749.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18435.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18690.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16293.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12486.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8486.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13866.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25200.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9772.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27174.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27424.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1875.0,"10th_percentile":1875.0,"90th_percentile":1875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5154.6,"maximum":16658.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12329.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8959.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11198.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11352.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9897.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7584.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5154.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8422.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15307.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6815.66},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16506.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16658.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11564.14,"maximum":37372.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27659.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20099.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25123.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25469.4},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22203.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17015.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11564.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18895.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34341.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13717.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37031.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14802.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37372.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6729.66,"maximum":21748.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16096.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11696.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14620.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14821.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12921.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9902.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6729.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10996.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9044.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19984.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7940.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21549.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8614.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21748.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8857.23,"maximum":28624.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21185.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15394.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19242.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19507.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17006.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13032.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8857.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14472.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26302.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8951.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28362.94},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11337.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28624.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15391.15,"maximum":49739.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36813.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26750.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33437.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33898.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29551.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22646.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15391.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25148.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45706.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16027.0},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49286.11},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19701.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49739.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5474.72,"maximum":17692.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13094.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9515.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11893.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12057.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10511.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8055.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5474.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8945.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16258.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6009.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17531.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7007.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17692.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":8855.85,"10th_percentile":8855.85,"90th_percentile":8855.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6193.52,"10th_percentile":6193.52,"90th_percentile":6193.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7337.81,"maximum":23713.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17551.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12753.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15941.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16161.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14088.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10797.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7337.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11989.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9862.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8964.77},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23497.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23713.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5908.74,"maximum":19095.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14132.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10269.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12836.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13013.69},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11345.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8694.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5908.74},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9654.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7941.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6636.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18921.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7563.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19095.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":13855.81,"10th_percentile":13855.81,"90th_percentile":13855.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6728.23,"10th_percentile":6728.23,"90th_percentile":6728.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9654.81,"10th_percentile":9654.81,"90th_percentile":9654.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":13877.98,"10th_percentile":13877.98,"90th_percentile":13877.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":11195.93,"10th_percentile":11195.93,"90th_percentile":11195.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5330.23,"10th_percentile":5330.23,"90th_percentile":5330.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":19485.33,"10th_percentile":19485.33,"90th_percentile":19485.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12678.99,"maximum":40974.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30326.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22036.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27545.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27924.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24344.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18656.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16716.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12678.99},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20717.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17040.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37652.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13682.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40601.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16229.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40974.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":22148.51,"10th_percentile":22148.51,"90th_percentile":22148.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6518.82,"10th_percentile":6518.82,"90th_percentile":6518.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8918.76,"maximum":28822.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21332.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15501.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19376.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19643.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17124.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13123.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8918.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14573.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11987.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26485.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9639.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28559.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11416.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28822.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14695.74,"maximum":48550.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35933.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26111.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32638.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33087.87},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28845.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22105.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15023.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24547.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20191.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44613.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14695.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48107.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48550.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23644.14,"maximum":76411.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56553.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41095.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51367.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52074.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45397.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34790.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31173.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23644.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38634.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31778.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70215.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26880.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75714.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30265.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76411.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16884.37,"maximum":54565.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40385.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29346.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36681.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37186.91},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32418.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24844.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22260.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16884.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27588.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22693.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50140.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17004.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54067.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54565.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16884.37,"maximum":54565.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40385.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29346.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36681.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37186.91},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32418.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24844.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22260.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16884.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27588.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22693.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50140.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18094.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54067.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21612.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54565.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23039.26,"maximum":74456.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55106.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40043.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50052.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50742.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44236.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33900.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23039.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":37645.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68418.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26946.94},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73777.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29490.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74456.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5212.87,"maximum":16846.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12468.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9060.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11324.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11481.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10008.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7670.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5212.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8517.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15480.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5721.94},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16692.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6672.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16846.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6696.93,"maximum":21642.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16018.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11639.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14549.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14749.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12858.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9854.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8829.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6696.93},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10942.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19887.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7262.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21445.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21642.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":27662.57,"10th_percentile":27662.57,"90th_percentile":27662.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11496.72,"maximum":37154.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27498.58},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19982.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24976.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25320.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22074.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16916.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15157.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11496.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18785.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11764.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36815.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14716.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37154.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2160.0,"10th_percentile":2160.0,"90th_percentile":2160.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5388.96,"maximum":17415.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12889.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9366.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11707.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11868.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10347.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7929.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7104.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5388.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8805.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6376.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17256.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17415.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7191.83,"maximum":23241.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17201.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12499.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15624.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15839.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13808.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10582.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9481.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7191.83},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11751.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21357.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7414.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23029.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23241.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8849.37,"maximum":28598.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21166.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15380.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19490.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13021.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8849.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14459.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26279.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10441.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28337.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11327.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28598.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5987.96,"maximum":19351.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14322.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10407.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13008.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13188.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11497.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8810.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5987.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9784.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8047.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17782.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6308.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19174.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7664.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19351.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6689.86,"10th_percentile":6689.86,"90th_percentile":6689.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8527.94,"maximum":27559.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20397.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14822.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18527.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18782.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16373.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12548.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8527.94},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13934.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25325.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9304.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27308.5},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27559.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9637.51,"10th_percentile":9637.51,"90th_percentile":9637.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14872.68,"maximum":48064.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35573.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25849.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32310.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32756.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28556.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21884.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19608.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14872.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24301.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19989.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44166.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16881.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47625.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48064.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7269.05,"10th_percentile":7269.05,"90th_percentile":7269.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6257.01,"maximum":20220.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14965.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10875.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13593.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13780.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12013.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9206.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8249.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6257.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10223.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18581.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6745.0},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20036.44},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20220.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9137.41,"maximum":29529.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21855.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15881.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19851.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20124.64},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17544.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13445.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12047.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9137.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14930.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12280.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9852.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29260.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29529.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14962.36,"maximum":48354.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35787.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26005.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32505.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32953.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28728.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22016.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19726.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14962.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24448.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20109.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44433.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16926.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47913.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19152.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48354.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5862.92,"maximum":18947.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14023.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10190.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12737.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12912.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11257.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8626.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5862.92},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9579.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17410.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6608.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18774.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18947.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11848.91,"maximum":38292.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28340.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20594.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25741.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26096.58},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22750.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17434.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15621.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11848.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19360.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15925.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14404.83},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37943.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38292.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5402.06,"maximum":17457.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12920.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9389.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11735.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11897.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10372.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7948.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5402.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8826.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16042.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6784.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17298.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17457.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6818.69,"maximum":22036.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16309.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11851.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14813.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15017.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13092.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10033.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8989.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6818.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11141.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20249.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7210.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21835.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8728.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22036.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3960.55,"maximum":12799.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9473.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6883.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8604.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8722.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7604.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5827.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5221.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3960.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6471.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11761.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4651.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12682.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12799.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9304.34,"maximum":30069.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22254.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16171.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20213.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20492.3},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17864.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13690.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12267.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9304.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15203.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12505.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27630.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10747.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29794.71},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11909.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30069.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5701.22,"maximum":18424.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13636.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9909.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12385.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12556.64},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10946.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8388.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7516.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5701.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9315.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7662.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16930.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6340.59},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18256.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18424.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1596.0,"10th_percentile":1596.0,"90th_percentile":1596.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9636.9,"maximum":31143.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23050.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16749.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20936.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21224.74},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18503.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14180.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12705.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9636.9},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15746.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12952.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11008.65},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30859.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31143.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5996.47,"maximum":19378.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14342.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10422.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13027.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13206.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11513.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8823.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5996.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9798.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17807.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6582.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19202.11},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7675.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19378.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6892.29,"10th_percentile":6892.29,"90th_percentile":6892.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9905.95,"maximum":32013.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23693.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17217.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21520.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21817.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19019.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14575.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13060.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9905.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16186.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29417.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11241.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31721.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12679.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32013.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23322.06,"maximum":75370.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55783.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40535.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50667.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51365.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44779.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34316.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30748.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23322.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38107.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69258.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25681.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74682.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29852.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75370.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13529.36,"maximum":43723.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32360.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23514.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29392.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29797.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25976.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19907.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17837.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13529.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22106.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40177.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15422.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43324.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17317.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43723.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8924.65,"maximum":28841.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21346.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15511.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19388.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19656.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17135.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13131.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8924.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14582.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11994.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26503.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10150.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28578.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28841.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15622.23,"maximum":50486.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37366.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27152.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33939.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34407.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29995.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22987.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20596.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15622.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25526.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20996.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46392.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18121.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50026.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50486.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17632.84,"10th_percentile":17632.84,"90th_percentile":17632.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11073.82,"maximum":35787.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26487.07},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19247.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24057.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24389.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21262.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16294.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11073.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18094.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32885.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12545.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35461.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35787.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":13888.47,"10th_percentile":13888.47,"90th_percentile":13888.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8941.02,"maximum":28894.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21385.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15540.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19424.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19692.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13156.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8941.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14609.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26551.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9823.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28631.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28894.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":14609.5,"10th_percentile":14609.5,"90th_percentile":14609.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22304.1,"maximum":72080.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53348.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38765.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48455.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49123.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":42824.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":32818.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29406.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22304.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":36444.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29977.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66235.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25819.39},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71423.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":28549.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72080.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11374.3,"maximum":36758.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27205.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19769.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24710.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25051.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21839.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16736.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14996.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11374.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18585.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15287.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33777.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13840.3},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36423.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36758.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9161.63,"maximum":29607.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21913.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15923.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19903.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20177.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17590.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13480.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9161.63},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14969.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12313.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27206.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10557.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29337.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29607.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27187.03,"maximum":87860.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65027.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47252.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59063.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59877.95},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52200.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40003.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35844.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27187.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44423.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36540.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80736.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31858.55},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87059.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":34800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87860.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14322.78,"maximum":46287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34258.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24893.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31116.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31545.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27500.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21074.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18883.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14322.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23403.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42533.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16923.77},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45864.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18333.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46287.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9821.5,"maximum":31740.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23491.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17070.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21337.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21631.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18857.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14451.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12948.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9821.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16048.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29166.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10986.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31450.79},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12571.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31740.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72148.74,"maximum":233164.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":172569.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125399.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156743.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":158903.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":138528.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":106161.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95122.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":72148.74},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":117890.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96969.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":214257.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":231037.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":92352.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233164.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47255.55,"maximum":152716.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":113028.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82133.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102662.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":104077.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":90732.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":69533.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62303.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":47255.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":77214.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63512.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140333.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":151323.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":60488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152716.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36803.64,"maximum":118939.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":88029.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63967.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79956.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81058.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":70664.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":54153.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48522.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36803.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":60136.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49465.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117853.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":47109.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118939.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58980.09,"maximum":190607.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":141072.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102511.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128134.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":129900.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":113244.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":86784.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77760.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":58980.09},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":96372.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175150.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":188868.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":75496.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190607.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37753.51,"maximum":122008.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":90301.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65618.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82019.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83150.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":72488.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":55551.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49775.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37753.51},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":61688.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50741.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112115.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":120895.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":48325.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122008.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12884.55,"maximum":41639.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30818.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22394.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27991.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28377.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24738.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18958.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12884.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21053.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38262.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13706.5},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41259.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41639.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14671.5,"10th_percentile":14671.5,"90th_percentile":14671.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14815.62,"10th_percentile":14815.62,"90th_percentile":14815.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":18958.69,"10th_percentile":18958.69,"90th_percentile":18958.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":22514.87,"10th_percentile":22514.87,"90th_percentile":22514.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6914.27,"maximum":22344.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16537.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12017.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15021.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15228.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13275.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10173.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6914.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11297.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20533.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7757.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22141.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8850.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22344.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7804.2,"10th_percentile":7804.2,"90th_percentile":7804.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5756.98,"10th_percentile":5756.98,"90th_percentile":5756.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4664.28,"maximum":15073.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11156.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8106.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10133.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10272.83},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6863.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4664.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7621.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6268.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13851.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4810.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14936.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15073.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12023.7,"maximum":38857.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28759.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20897.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26121.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26481.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23085.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17692.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12023.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19646.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35706.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12757.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38502.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15390.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38857.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7404.59,"maximum":23929.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17710.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12869.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16086.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16308.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14217.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10895.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9762.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7404.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12098.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21989.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8461.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23711.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23929.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8356.14,"10th_percentile":8356.14,"90th_percentile":8356.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5586.01,"maximum":18052.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13360.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9708.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12135.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12302.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10725.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8219.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5586.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9127.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6599.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17887.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18052.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10671.88,"maximum":34488.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25525.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18548.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23184.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23504.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20490.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15702.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10671.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17437.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31691.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12315.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34173.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13660.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34488.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10340.16,"10th_percentile":10340.16,"90th_percentile":10340.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5506.8,"maximum":17796.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13171.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9571.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11963.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12128.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10573.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8102.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7260.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5506.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8998.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16353.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6368.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17634.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17796.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6355.31,"10th_percentile":6355.31,"90th_percentile":6355.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6215.02,"10th_percentile":6215.02,"90th_percentile":6215.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6000.0,"10th_percentile":6000.0,"90th_percentile":6000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4067.91,"maximum":13146.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9729.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7070.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8837.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8959.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7810.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5985.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4067.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6646.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5467.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4627.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13026.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5207.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13146.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11748.75,"maximum":37968.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28101.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20420.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25524.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25875.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22558.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17287.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15489.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11748.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19197.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15790.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34889.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13910.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37622.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15038.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37968.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7135.62,"10th_percentile":7135.62,"90th_percentile":7135.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30777.06,"maximum":99462.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":73614.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53492.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66863.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67784.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":59093.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":45286.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40577.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30777.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":50289.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91397.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98555.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":39395.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99462.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24259.5,"maximum":78399.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58025.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42164.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52703.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53430.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46579.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":35696.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31984.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24259.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39639.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":77684.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31052.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78399.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21141.47,"maximum":68323.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50567.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36745.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45929.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46562.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40592.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31108.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27873.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21141.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34544.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28414.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62783.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25444.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67700.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27061.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68323.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34017.51,"maximum":109935.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":81365.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59124.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73903.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74921.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":65314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":50054.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44849.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":34017.51},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":55584.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45720.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101020.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":41617.87},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":108932.13},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":43543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109935.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18325.23,"maximum":59221.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43831.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31850.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39811.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40360.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":35185.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26964.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24160.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18325.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29943.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24629.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54419.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21139.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58681.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59221.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13856.03,"maximum":44778.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33141.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24082.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30102.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30517.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26604.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20388.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18268.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13856.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22640.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18622.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41147.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15503.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44370.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44778.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20842.3,"maximum":67356.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49851.94},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36225.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45280.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45904.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30667.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27479.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20842.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34056.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28012.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61894.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24509.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66742.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67356.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11979.84,"maximum":38715.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28654.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20821.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26026.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26384.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17627.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11979.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19574.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16101.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35576.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14539.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38362.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38715.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10158.64,"maximum":32829.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24298.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17656.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22069.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22373.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19505.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14947.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13393.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10158.64},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16599.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30167.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11800.94},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32530.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13003.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32829.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16633.65,"maximum":53755.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39785.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28910.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36136.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36634.7},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31937.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24475.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21930.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16633.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27179.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22356.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49396.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20144.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53264.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53755.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8652.32,"maximum":27961.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20695.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15038.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18797.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19056.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16612.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12731.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8652.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14137.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11628.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25694.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10679.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27706.8},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11075.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27961.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":8855.85,"10th_percentile":8855.85,"90th_percentile":8855.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6778.1,"maximum":21904.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16212.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11780.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14725.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14928.4},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13014.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9973.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6778.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11075.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9109.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20128.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8194.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21705.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8676.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21904.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20041.68,"maximum":64769.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47936.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34833.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43540.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44140.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":38480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29489.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26423.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20041.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32747.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26936.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59517.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23789.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64178.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64769.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9951.78,"maximum":32161.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23803.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17296.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21620.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21918.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19107.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14643.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13120.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9951.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16261.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13375.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29553.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11451.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31867.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12738.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32161.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6853.38,"maximum":22148.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16392.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11911.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14889.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15094.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13158.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10084.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6853.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11198.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9211.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20352.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8318.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21946.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8772.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22148.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20432.5,"maximum":66032.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48871.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35513.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44389.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45001.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39231.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30064.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26938.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20432.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33386.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60677.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22314.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65429.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66032.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11451.55,"maximum":37008.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27390.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19903.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24878.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25221.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21987.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16850.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15098.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11451.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18711.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15391.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34007.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13298.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36670.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14658.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37008.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7056.21,"maximum":23402.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17320.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12586.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15732.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15949.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13904.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10655.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7241.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11832.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21505.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7056.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23189.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23402.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19115.37,"maximum":61775.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45721.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33223.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41528.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42100.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36702.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28126.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25202.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19115.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31234.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20959.65},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61211.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61775.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10159.95,"maximum":32834.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24301.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17658.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22072.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22376.74},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19507.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14949.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10159.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16601.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30171.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11619.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32534.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13005.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32834.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7726.01,"maximum":24968.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18479.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13428.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16784.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17016.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11368.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7726.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12624.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10383.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22943.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8755.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24740.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9889.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24968.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22615.06,"maximum":73085.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54092.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39306.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49131.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49808.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43421.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33276.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29816.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22615.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":36952.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67159.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24470.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72418.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":28947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73085.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16098.81,"maximum":52026.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38506.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27980.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34974.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35456.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30910.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23688.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16098.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26305.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21637.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47808.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17417.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51552.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20606.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52026.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12169.03,"maximum":39326.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29106.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21150.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26437.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26801.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23365.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17905.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16043.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12169.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19884.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16355.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36137.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13396.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38968.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39326.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19064.96,"maximum":61612.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45600.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33136.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41418.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41989.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36605.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28052.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19064.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31151.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25623.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56616.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22690.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61050.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24403.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61612.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21531.06,"10th_percentile":21531.06,"90th_percentile":21531.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15884.54,"10th_percentile":15884.54,"90th_percentile":17441.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13711.35,"maximum":44311.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32795.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23831.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30198.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26326.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20175.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18077.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13711.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22404.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40718.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15693.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43907.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17550.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44311.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10677.11,"maximum":34505.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25538.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18557.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23196.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23515.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20500.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15710.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14077.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10677.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17446.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12367.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34190.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13666.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34505.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17981.42,"maximum":58642.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43402.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31538.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39421.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39965.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34840.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26700.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23923.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18145.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29650.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24388.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53887.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17981.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58107.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58642.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21125.76,"maximum":68272.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50529.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36717.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45895.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46528.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40562.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31085.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27852.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21125.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34519.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28393.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62736.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24648.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67649.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68272.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13689.09,"maximum":44239.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32742.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23792.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29739.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30149.48},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26283.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20142.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13689.09},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22367.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40651.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16166.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43835.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44239.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10252.91,"maximum":33134.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24523.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17820.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22274.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22581.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19685.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15086.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13517.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10252.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16753.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30447.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12081.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32832.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33134.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11579.86,"maximum":37422.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27697.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20126.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25157.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25504.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22233.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17038.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15267.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11579.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18921.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34388.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14802.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37081.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14822.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37422.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7310.97,"maximum":23627.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17486.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12706.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15883.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16102.02},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10757.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9638.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7310.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11946.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21711.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9463.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23411.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23627.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24035.62,"maximum":77676.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":57489.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41775.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52217.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52937.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46149.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":35366.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31689.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24035.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39273.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32304.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71377.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25898.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76967.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77676.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16602.22,"maximum":53653.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39710.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28855.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36068.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36565.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31876.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24428.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21888.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16602.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27127.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17304.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53164.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53653.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13135.27,"maximum":42449.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31417.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22829.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28536.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28929.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25220.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19327.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13135.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21462.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17654.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39007.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13616.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42062.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42449.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14818.22,"10th_percentile":14818.22,"90th_percentile":14818.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23735.14,"maximum":76705.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56771.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41253.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51564.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52275.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45572.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34924.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31293.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23735.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38782.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31900.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70485.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25802.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76005.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30381.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76705.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11808.98,"maximum":38163.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28245.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20524.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25655.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26008.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22673.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17376.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11808.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19295.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35068.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15338.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37815.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38163.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7909.97,"maximum":25562.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18919.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13748.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17184.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17421.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11638.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10428.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7909.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12924.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10631.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11044.73},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25329.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25562.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18402.37,"maximum":63823.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47237.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34325.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42904.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43496.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37918.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":29059.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26037.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19749.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":32269.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26543.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58648.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18402.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63241.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":25279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63823.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8651.32,"maximum":42625.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31547.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22924.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28654.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29049.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19407.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13189.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21551.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17727.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39168.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8651.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42236.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16883.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42625.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20717.92,"maximum":66954.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49554.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36009.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45009.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45630.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30484.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27315.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20717.92},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33852.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27845.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61525.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22665.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66343.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26519.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66954.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11443.69,"maximum":36982.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27371.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19889.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24861.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25204.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21972.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16838.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11443.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18698.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15380.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33983.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12613.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36645.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36982.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8810.75,"maximum":28473.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21074.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15313.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19141.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19405.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16916.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12964.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11616.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8810.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14396.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26164.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9927.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28214.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28473.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18271.55,"maximum":59048.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43703.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31757.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39695.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40242.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":35082.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26885.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24089.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18271.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29855.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24557.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54260.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20420.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58509.83},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59048.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12236.46,"maximum":39544.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29267.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21267.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26583.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26950.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23494.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18005.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12236.46},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19994.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36338.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13053.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39184.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39544.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11736.31,"maximum":37928.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28071.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20398.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25497.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25848.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22534.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17269.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15473.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11736.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19176.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15773.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34852.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12639.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37582.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15022.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37928.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4939.88,"maximum":15964.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11815.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8585.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10731.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10879.82},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9484.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7268.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4939.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8071.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6639.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14669.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5700.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15818.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15964.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16246.1,"maximum":52502.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38858.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28236.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35294.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35781.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":31193.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23904.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16246.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26545.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48245.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19002.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52023.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52502.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7550.57,"maximum":24401.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18059.94},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13123.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16403.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16629.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14497.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11110.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9954.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7550.57},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12337.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10148.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22422.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9045.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24178.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24401.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5474.07,"maximum":17690.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13093.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9514.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11892.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12056.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10510.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8054.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5474.07},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8944.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7357.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16256.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6089.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17529.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7006.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17690.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12640.37,"maximum":40850.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30234.03},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21969.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27461.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27839.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24270.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18599.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16665.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12640.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20654.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37537.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14908.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40477.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40850.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7902.77,"maximum":25539.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18902.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13735.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17168.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17405.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15173.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11628.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7902.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12913.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10621.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23468.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8968.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25306.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10115.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25539.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5722.17,"maximum":18492.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13686.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9945.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12431.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12602.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10986.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8419.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7544.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5722.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9349.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7690.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16992.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6494.69},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18323.76},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18492.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10972.35,"maximum":35459.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26244.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19070.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23837.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24166.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21067.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16145.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14466.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10972.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17928.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14747.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32584.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11947.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35136.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14044.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35459.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50414.28,"10th_percentile":50414.28,"90th_percentile":50414.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6293.02,"maximum":20337.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15052.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10937.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13671.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13860.02},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12082.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9259.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8296.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6293.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10282.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8457.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18688.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6854.75},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20151.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8055.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20337.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6836.44,"10th_percentile":6836.44,"90th_percentile":6836.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7108.53,"10th_percentile":7108.53,"90th_percentile":7115.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8486.05,"maximum":27424.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20297.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14749.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18435.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18690.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16293.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12486.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8486.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13866.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25200.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9663.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27174.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27424.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5434.13,"maximum":17561.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12997.71},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9444.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11805.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11968.38},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10433.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7995.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5434.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8879.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16137.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5917.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17401.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17561.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8652.98,"maximum":27964.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20696.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15039.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18798.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19057.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12732.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8652.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14138.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11629.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25696.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9887.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27708.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11076.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5437.41,"maximum":17572.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13005.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9450.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11812.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11975.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10440.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8000.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5437.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8884.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16147.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5951.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17411.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6960.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17572.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9733.78,"maximum":31456.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23281.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16917.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21146.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21438.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18689.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14322.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9733.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15904.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13082.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28906.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10961.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31169.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31456.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7011.21,"10th_percentile":7011.21,"90th_percentile":7011.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5847.21,"maximum":18896.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13985.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10162.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12703.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12878.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11226.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8603.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5847.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9554.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7858.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17364.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6475.14},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18724.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18896.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"1 through 10","median_amount":10162.82,"10th_percentile":10162.82,"90th_percentile":10162.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12208.31,"maximum":39453.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29200.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21218.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26522.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26888.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23440.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17963.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16095.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12208.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19948.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16408.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36254.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13544.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39093.9},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39453.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":22432.92,"10th_percentile":22432.92,"90th_percentile":22432.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7371.86,"maximum":23823.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17632.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12812.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16015.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16236.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14154.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10847.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7371.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12045.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21891.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7843.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23606.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23823.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26365.94,"10th_percentile":26365.94,"90th_percentile":26365.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5262.62,"maximum":17007.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12587.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9146.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11433.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11590.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7743.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5262.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8599.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7073.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15628.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5618.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16852.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17007.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9327.25,"maximum":30143.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22309.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16211.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20263.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20542.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17908.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13724.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9327.25},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15240.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27698.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10126.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29868.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30143.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5862.27,"maximum":18945.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14021.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10189.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12735.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12911.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11255.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8625.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5862.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9578.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6419.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18772.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18945.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10104.96,"maximum":32656.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24169.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17563.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21953.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22255.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19401.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14868.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13322.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10104.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16511.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13581.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30008.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11365.7},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32358.49},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32656.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7198.79,"10th_percentile":7198.79,"90th_percentile":7198.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6378.77,"maximum":20614.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15257.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11086.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13857.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14048.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12247.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9385.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6378.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10422.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7370.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20426.35},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8165.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20614.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4905.19,"maximum":15852.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11732.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8525.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10656.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10803.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9418.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7217.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4905.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8015.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14566.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5695.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15707.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15852.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19253.5,"maximum":62221.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46051.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33463.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41828.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42404.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28330.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25384.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19253.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31459.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25877.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57176.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21597.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61654.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62221.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11060.08,"maximum":35743.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26454.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19223.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24028.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24359.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21235.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16274.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14581.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11060.08},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18072.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14865.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32844.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12570.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35416.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35743.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7504.09,"maximum":24251.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17948.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13042.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16302.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16527.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14408.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11041.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9893.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7504.09},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12261.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10085.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22284.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8431.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24029.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9605.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24251.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39955.11,"maximum":138601.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":102581.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74541.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93174.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94458.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":82346.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":63106.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56544.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42887.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":70078.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57642.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127362.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39955.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137337.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":54897.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138601.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22725.03,"maximum":73440.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54355.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39497.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49370.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50050.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43632.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33438.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29961.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22725.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":37132.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30543.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67485.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23466.57},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72770.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29088.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73440.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11763.81,"maximum":38017.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28137.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20446.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25556.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25909.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22586.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17309.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15509.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11763.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19221.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15810.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13207.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37670.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15057.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38017.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32085.02,"maximum":103689.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":76742.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55765.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69704.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70665.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":61604.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":47210.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42301.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32085.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":52426.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43123.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95281.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36450.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":102743.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":41069.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103689.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17352.44,"maximum":56078.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41504.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30159.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37698.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38217.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":33317.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":25532.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22877.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17352.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28353.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23322.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51530.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18158.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55566.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22211.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56078.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10516.07,"maximum":33985.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25153.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18277.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22846.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23161.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15473.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10516.07},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17183.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14133.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12233.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33674.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33985.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21200.39,"maximum":68513.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50708.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36847.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46057.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46692.69},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31194.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21200.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34641.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28493.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62957.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22446.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67888.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27137.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68513.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11312.11,"maximum":36557.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27057.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19661.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24575.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24914.3},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21719.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16644.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11312.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18483.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33593.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12092.6},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36224.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36557.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12773.77,"10th_percentile":12773.77,"90th_percentile":12773.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9432.33,"maximum":30530.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22596.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16419.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20523.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20806.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18138.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13900.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12455.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9447.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15436.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12697.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28054.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9432.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30251.71},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30530.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11867.09,"maximum":40759.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30166.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21920.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27400.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27777.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24215.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18557.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16628.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12612.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20608.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37454.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11867.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40387.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40759.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10985.34,"maximum":36481.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27000.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19620.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24524.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24862.4},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21674.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16610.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11288.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18445.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15172.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10985.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36148.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14449.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36481.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13744.08,"maximum":45288.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33519.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24356.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30445.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30864.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26907.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20620.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18476.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14013.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22898.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18834.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41616.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13744.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44875.49},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17938.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45288.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12628.58,"maximum":40812.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30205.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21949.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27435.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27813.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24247.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18582.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12628.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20634.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16973.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37502.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12758.6},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40439.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16164.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40812.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12669.17,"maximum":40943.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30302.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22019.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27523.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27903.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24325.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18641.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12669.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20701.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17027.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37623.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13412.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40569.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16216.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40943.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7765.95,"maximum":25097.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18575.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13497.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16871.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17104.07},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14910.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11427.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7765.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12689.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10437.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23062.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8628.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24868.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9940.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25097.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5674.38,"maximum":18338.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13572.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9862.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12327.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12497.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10895.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8349.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7481.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5674.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9271.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7626.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16851.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6086.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18170.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18338.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13882.87,"maximum":44865.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33205.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24129.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30160.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30576.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26655.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20427.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18303.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13882.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22684.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41227.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15279.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44456.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44865.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7086.43,"maximum":22901.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16949.79},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12316.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15395.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15607.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13606.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10427.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9342.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7086.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11579.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9524.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21044.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7322.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22692.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9070.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22901.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10913.44,"maximum":35269.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26103.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18968.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23709.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24036.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20954.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16058.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10913.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17832.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14667.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12725.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34947.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35269.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7405.9,"maximum":23933.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17713.9},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12871.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16089.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16311.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14219.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10897.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7405.9},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12101.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21993.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8183.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23715.44},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23933.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5036.77,"maximum":16277.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12047.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8754.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10942.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11093.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9670.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7411.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6640.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5036.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8230.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6769.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14957.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5227.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16128.93},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6447.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16277.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4832.52,"maximum":15617.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11558.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8399.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10498.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10643.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9278.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7110.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4832.52},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7896.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6495.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14350.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5310.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15474.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6185.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15617.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7739.11,"maximum":25010.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18510.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13451.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16813.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17044.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14859.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11387.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7739.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12645.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22982.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7810.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24782.46},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25010.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4805.03,"maximum":15528.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11492.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8351.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10438.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10582.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9225.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7070.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4805.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7851.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14269.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5255.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15386.84},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15528.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8716.48,"maximum":28169.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20848.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15149.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18936.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19197.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16735.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12825.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8716.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14242.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11715.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25884.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9708.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27912.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28169.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4920.24,"maximum":15900.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11768.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8551.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10689.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10836.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7239.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6486.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4920.24},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8039.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5491.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15755.79},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15900.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5218.1,"maximum":16863.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12480.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9069.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11336.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11492.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10018.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7678.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6879.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5218.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8526.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15496.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5715.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16709.61},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6679.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16863.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8323.7,"maximum":26899.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19909.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14467.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18083.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18332.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12247.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10974.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8323.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13600.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11187.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24718.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9327.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26654.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10654.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26899.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13861.26,"maximum":44795.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33154.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24091.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30113.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30528.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26614.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20395.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18275.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13861.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22649.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41163.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14497.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44387.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44795.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7870.69,"maximum":25435.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18825.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13679.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17099.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17334.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15112.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11581.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10376.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7870.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12860.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10578.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23373.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25203.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10074.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25435.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11344.19,"maximum":36661.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27133.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19716.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24984.95},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21781.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16692.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11344.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18536.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33688.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36326.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36661.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24526.59,"maximum":79263.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58664.26},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42628.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53284.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54018.48},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":47092.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":36089.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32336.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24526.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":40076.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32964.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72835.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78539.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79263.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10450.61,"maximum":33773.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24996.43},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18163.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22704.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23016.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20065.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15377.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13778.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10450.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17076.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31034.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33465.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13377.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33773.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14278.27,"maximum":46143.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34151.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24816.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31019.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31447.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27414.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21009.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14278.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23330.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19190.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45722.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46143.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27922.19,"maximum":90236.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66786.07},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48530.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60661.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61497.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":53611.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":41085.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36813.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27922.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45624.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37528.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82919.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89413.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90236.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8089.34,"maximum":26142.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19348.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14059.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17574.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17816.32},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15531.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11902.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10665.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8089.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13217.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10872.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24022.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9278.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25903.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10354.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26142.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5801.38,"maximum":18748.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13876.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10083.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12603.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12777.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11138.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8536.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7648.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5801.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9479.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17228.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6475.14},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18577.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7425.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18748.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9775.02,"maximum":31590.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23380.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16989.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21236.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21528.96},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18768.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14383.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9775.02},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15972.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29028.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10022.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31301.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12512.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31590.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6646.52,"maximum":21479.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15897.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11552.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14439.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14638.6},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12761.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9779.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8762.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6646.52},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10860.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8933.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8945.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21283.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21479.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14205.6,"maximum":45908.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33977.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24690.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30861.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31287.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27275.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20902.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18729.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14205.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23211.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42185.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17173.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45489.71},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18183.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45908.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5026.3,"maximum":16243.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12022.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8736.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10919.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11070.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9650.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7395.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6626.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5026.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8212.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6755.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14926.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5933.92},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16095.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16243.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8661.49,"maximum":27991.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20717.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15054.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18817.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19076.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16630.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12744.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11419.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8661.49},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14152.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25721.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10444.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27736.15},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11086.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27991.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5227.92,"maximum":16895.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12504.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9086.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11357.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11514.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10037.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7692.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8542.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15525.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5869.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16741.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16895.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":47347.72,"10th_percentile":47347.72,"90th_percentile":47347.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5144.13,"maximum":16624.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12304.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8940.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11175.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11329.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9876.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7569.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5144.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8405.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6913.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15276.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5807.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16472.73},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6584.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16624.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7615.38,"maximum":24610.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18214.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13236.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16544.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16772.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14621.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11205.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7615.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12443.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22615.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9530.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24386.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24610.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7102.15,"maximum":22952.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16987.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12343.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15429.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15642.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13636.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10450.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7102.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11604.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21090.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8243.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22742.76},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9090.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22952.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11836.47,"maximum":38252.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28311.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20572.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25714.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26069.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22726.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17416.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15605.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11836.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19340.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15908.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14214.65},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37903.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15151.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38252.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.01,"maximum":32472.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24033.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17464.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21829.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22130.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14784.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13247.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10048.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16418.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13504.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29839.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11170.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32176.11},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12861.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32472.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6397.76,"maximum":20675.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15302.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11119.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13899.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14090.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12283.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9413.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8434.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6397.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10453.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18999.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7356.89},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20487.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8189.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20675.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11750.72,"maximum":37975.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28106.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20423.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25528.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25880.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22561.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17290.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11750.72},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19200.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15793.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34895.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13738.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37628.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15041.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37975.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7066.8,"maximum":22837.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16902.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12282.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15352.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15564.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13568.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10398.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7066.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11547.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20986.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7766.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22629.56},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22837.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26870.27,"maximum":88889.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65788.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47805.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59755.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60578.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52811.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40471.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27505.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44943.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36967.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81681.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26870.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88078.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88889.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15309.32,"maximum":49475.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36617.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26608.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33259.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33717.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29394.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22526.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20184.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15309.32},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":25015.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45463.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18373.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49024.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49475.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10745.2,"maximum":34725.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25701.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18675.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23343.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23665.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20631.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15810.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10745.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17557.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14441.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31909.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12267.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34408.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34725.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9695.16,"maximum":31332.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23189.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16850.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21062.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21353.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18615.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14265.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9695.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15841.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28791.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11110.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31046.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12410.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31332.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11039.8,"10th_percentile":11039.8,"90th_percentile":11039.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":14265.73,"10th_percentile":14265.73,"90th_percentile":14265.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":17992.64,"10th_percentile":17992.64,"90th_percentile":17992.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5733.3,"maximum":18528.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13713.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9964.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12455.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12627.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11008.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8436.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5733.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9368.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17025.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6745.0},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18359.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7338.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18528.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6528.45,"10th_percentile":6528.45,"90th_percentile":6528.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6589.81,"10th_percentile":6589.81,"90th_percentile":6589.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":8436.14,"10th_percentile":8436.14,"90th_percentile":8436.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6476.07,"10th_percentile":6476.07,"90th_percentile":6476.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3929.78,"maximum":12699.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9399.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6830.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8537.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8655.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7545.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5782.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5181.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3929.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6421.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5281.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11670.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4625.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12584.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5030.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12699.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11807.67,"maximum":38159.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28242.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20522.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25652.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26005.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22671.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17374.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15567.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11807.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19293.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15869.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35064.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13200.6},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37810.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15114.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38159.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6859.28,"maximum":22167.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16406.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11921.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14901.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15107.18},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13170.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10092.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6859.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11207.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20369.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7912.39},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21965.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8780.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22167.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5173.59,"maximum":16719.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12374.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8992.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11239.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11394.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9933.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7612.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6821.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5173.59},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8453.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6953.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15363.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5797.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16567.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16719.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7595.74,"maximum":24547.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18167.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13201.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16501.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16729.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14584.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11176.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7595.74},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12411.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22556.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8408.52},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24323.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24547.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8649.19,"10th_percentile":8649.19,"90th_percentile":8649.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8562.7,"10th_percentile":8562.7,"90th_percentile":8562.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5299.28,"maximum":17125.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12675.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9210.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11512.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11671.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10174.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7797.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6986.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5299.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8658.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15737.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5944.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16969.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17125.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6115.82,"10th_percentile":6115.82,"90th_percentile":6115.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8801.58,"maximum":28444.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21052.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15297.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19121.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19385.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16899.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12950.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8801.58},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14381.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11829.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26137.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10172.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28184.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11266.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28444.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5117.29,"maximum":16537.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12239.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8894.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11117.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11270.55},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9825.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7529.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5117.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8361.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15196.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5565.59},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16386.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16537.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7487.73,"maximum":24198.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17909.62},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13014.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16267.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16491.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14376.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11017.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9872.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7487.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12234.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10063.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22236.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8812.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23977.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24198.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4510.44,"maximum":14576.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10788.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7839.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9798.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9934.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8660.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6636.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4510.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7370.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6062.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13394.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5107.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14443.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14576.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7055.67,"maximum":22801.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16876.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12263.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15328.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15539.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13547.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10381.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7055.67},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11528.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9483.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20952.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7320.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22593.92},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9031.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22801.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10830.3,"maximum":35000.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25904.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18823.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23528.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23853.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20794.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15936.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14278.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10830.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17696.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32162.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12167.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34681.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35000.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12465.88,"10th_percentile":12465.88,"90th_percentile":12465.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15216.22,"10th_percentile":15216.22,"90th_percentile":15216.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7504.83,"10th_percentile":7504.83,"90th_percentile":7504.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6644.56,"maximum":21473.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15892.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11548.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14435.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14634.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12757.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9776.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8760.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6644.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10857.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19732.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7762.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21277.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21473.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7793.07,"10th_percentile":7793.07,"90th_percentile":7793.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4516.33,"maximum":14595.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10802.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7849.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9811.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9946.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8671.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6645.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4516.33},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7379.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6070.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13411.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5575.36},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14462.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5781.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14595.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13094.68,"maximum":42318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31320.7},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22759.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28448.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28840.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25142.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19267.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17264.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13094.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21396.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38886.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14056.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41932.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16761.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42318.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10043.43,"maximum":32457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24022.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17456.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21819.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22120.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19283.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14778.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13241.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10043.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16410.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13498.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29825.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10914.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32161.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12855.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32457.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15234.03,"maximum":49232.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36437.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26477.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33096.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33552.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29249.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22415.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15234.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24892.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20474.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45239.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18082.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48783.0},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19499.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49232.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9172.76,"maximum":29643.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21939.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15942.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19927.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20202.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17612.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13497.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9172.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14988.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12328.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27239.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11544.61},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29373.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11741.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29643.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13641.3,"maximum":44084.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32628.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23709.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29635.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30044.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26191.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20072.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17985.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13641.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22289.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40510.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16110.43},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43682.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17461.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44084.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7199.03,"maximum":23265.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17219.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12512.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15639.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15855.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13822.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10592.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7199.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11763.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21378.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7668.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23053.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23265.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9841.8,"maximum":31805.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23540.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17105.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21381.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21676.02},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18896.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14481.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9841.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16081.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29226.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10989.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31515.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12597.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31805.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6881.06,"maximum":22370.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16556.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12031.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15038.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15245.59},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13290.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10185.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6922.12},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11310.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20556.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6881.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22166.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22370.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14646.17,"maximum":47332.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35031.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25456.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31818.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32257.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28121.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21550.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19309.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14646.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23931.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19684.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43494.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16060.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46900.52},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47332.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9629.7,"maximum":31120.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23032.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16737.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20920.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21208.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18489.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14169.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12696.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9629.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15734.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12942.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28596.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11016.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30836.57},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31120.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12375.89,"maximum":39995.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29601.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21510.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26886.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27257.23},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23762.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18210.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16316.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12375.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20222.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36752.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13262.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39630.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15841.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39995.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8792.42,"maximum":28414.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21030.26},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15281.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19101.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19364.82},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16881.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12937.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8792.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14366.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26110.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9166.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28155.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28414.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14019.03,"maximum":45305.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33531.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24365.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30456.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30876.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20628.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18483.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14019.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22906.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18841.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41631.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15284.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44892.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17944.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45305.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9118.42,"maximum":29468.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21810.03},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15848.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19809.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20082.83},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17507.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13417.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12021.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9118.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14899.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27078.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10346.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29199.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29468.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11938.6,"maximum":38582.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28555.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20750.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25936.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26294.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22922.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17566.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11938.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19507.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16045.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35453.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13910.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38230.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38582.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13710.64,"10th_percentile":13710.64,"90th_percentile":13710.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13470.38,"10th_percentile":13470.38,"90th_percentile":13470.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6532.61,"maximum":21111.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15625.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11354.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14192.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14387.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12542.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9612.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8612.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6532.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10674.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19399.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7426.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20918.98},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8361.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21111.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5811.2,"maximum":18780.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13899.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10100.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12624.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12798.86},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11157.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8550.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7661.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5811.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9495.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17257.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6369.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18608.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18780.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9808.41,"maximum":31698.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23460.38},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17047.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21308.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21602.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18832.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14432.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9808.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16026.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29127.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10473.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31408.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12555.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31698.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5692.71,"maximum":18397.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13616.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9894.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12367.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12537.89},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10930.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8376.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5692.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9301.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16905.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6154.17},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18229.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7286.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18397.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6408.89,"maximum":20711.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15329.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11139.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13923.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14115.22},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12305.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9430.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6408.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10472.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19032.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7256.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20522.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8203.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20711.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4344.16,"maximum":14039.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10390.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7550.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9437.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9567.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6392.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4344.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7098.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12900.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4963.48},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13911.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14039.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6595.46,"maximum":21314.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15775.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11463.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14328.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14526.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12663.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9704.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8695.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6595.46},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10776.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8864.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19586.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6784.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21120.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21314.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3734.7,"maximum":12069.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8932.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6491.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8113.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8225.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7170.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5495.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3734.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6102.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5019.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11090.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4250.11},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11959.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12069.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7015.08,"maximum":22670.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16779.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12192.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15240.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15450.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13469.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10322.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7015.08},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11462.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20832.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7573.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22463.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22670.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10847.03,"maximum":35749.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26458.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19226.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24032.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24363.54},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21239.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16277.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11062.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18075.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10847.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35423.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35749.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5910.62,"maximum":21213.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15700.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11408.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14260.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14456.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12603.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9658.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6564.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10725.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19492.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5910.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21019.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8402.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21213.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4285.9,"maximum":13850.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10251.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7449.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9311.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9439.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8229.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6306.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5650.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4285.9},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7003.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5760.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5336.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13724.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13850.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4925.25,"10th_percentile":4925.25,"90th_percentile":4925.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5507.45,"maximum":17798.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13173.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9572.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11964.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12129.86},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10574.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8103.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5507.45},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8999.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8582.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17636.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17798.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16071.97,"maximum":51940.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38441.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27934.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34916.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35397.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30858.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23648.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16071.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26261.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47728.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16122.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51466.26},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20572.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51940.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6939.8,"maximum":22427.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16599.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12061.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15076.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15284.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13324.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10211.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6939.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11339.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9327.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20608.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7856.77},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22222.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22427.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6270.1,"maximum":20263.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14997.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10897.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13621.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13809.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12038.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9226.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6270.1},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10245.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18620.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6452.59},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20078.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20263.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10798.22,"maximum":34896.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25827.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18768.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23459.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23782.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20733.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15888.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10798.22},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17644.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14513.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32067.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12887.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34578.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34896.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7310.97,"maximum":23627.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17486.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12706.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15883.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16102.02},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10757.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9638.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7310.97},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11946.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21711.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7859.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23411.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23627.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6276.65,"maximum":20284.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15012.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10909.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13636.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13823.98},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12051.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9235.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8275.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6276.65},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10255.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18639.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6811.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20099.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20284.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11797.85,"maximum":38127.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28218.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20505.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25630.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25984.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22652.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17359.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11797.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19277.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15856.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35035.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12703.73},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37779.52},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38127.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38908.29,"maximum":125740.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":93063.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67625.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84528.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85693.38},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":74705.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":57250.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51297.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38908.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":63575.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52293.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115544.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":41892.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":124593.59},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":49803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125740.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26571.68,"maximum":85872.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":63555.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46183.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57727.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58522.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":51018.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":39098.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35032.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26571.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":43417.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35713.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78908.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28611.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85088.82},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":34012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85872.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16033.34,"maximum":51815.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38349.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27867.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34832.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35312.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30784.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23591.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21138.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16033.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26198.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21549.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47613.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17262.79},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51342.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51815.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27295.7,"maximum":88212.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65287.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47441.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59300.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60117.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52408.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40163.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35987.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27295.7},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44600.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36686.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81058.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29389.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87407.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":34939.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88212.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13702.84,"maximum":44283.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32775.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23816.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29769.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30179.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26310.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20162.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18066.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13702.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22390.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18417.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40692.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16426.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43879.75},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17540.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44283.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6749.95,"maximum":21813.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16144.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11731.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14664.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14866.4},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12960.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9932.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6749.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11029.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20045.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8246.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21614.95},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8640.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21813.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4776.88,"maximum":15437.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11425.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8302.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10377.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10520.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9171.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7028.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4776.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7805.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14185.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5581.37},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15296.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15437.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45247.13,"maximum":146226.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":108224.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78642.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98299.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":99654.33},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":86876.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":66577.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59655.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45247.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":73933.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134368.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":47539.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":144892.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":57917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146226.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12716.3,"maximum":41095.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30415.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22101.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27626.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28006.97},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18711.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12716.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20778.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37763.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14028.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40720.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41095.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14479.92,"10th_percentile":14479.92,"90th_percentile":22555.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14616.03,"10th_percentile":14616.03,"90th_percentile":14616.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":18711.13,"10th_percentile":18711.13,"90th_percentile":20778.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6202.78,"10th_percentile":6202.78,"90th_percentile":6202.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":41633.97,"10th_percentile":41633.97,"90th_percentile":41633.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9489.1,"10th_percentile":5949.08,"90th_percentile":14470.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":18277.55,"10th_percentile":18277.55,"90th_percentile":18277.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":14995.36,"10th_percentile":13887.95,"90th_percentile":22874.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":41934.69,"10th_percentile":41934.69,"90th_percentile":41934.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6698.89,"maximum":21648.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16022.83},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11643.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14553.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14753.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12862.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9856.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6698.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10945.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19893.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7812.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21451.44},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21648.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":9856.94,"10th_percentile":9856.94,"90th_percentile":34735.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6442.81,"10th_percentile":5973.89,"90th_percentile":7551.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25301.03,"maximum":81765.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60516.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43974.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54966.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55724.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":48578.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":37228.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33357.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25301.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41341.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75135.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27361.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81019.9},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81765.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6285.81,"maximum":20313.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15034.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10925.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13655.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13844.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12069.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9249.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6285.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10270.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8448.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6441.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20128.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8046.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20313.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6158.68,"maximum":19905.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14732.61},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10705.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13381.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13565.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9063.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8120.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6159.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10064.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18291.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6158.68},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19724.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19905.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5936.93,"maximum":22717.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16813.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12217.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15271.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15482.05},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13496.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10343.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7029.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11486.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20875.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5936.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22510.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22717.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10047.22,"maximum":41599.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30788.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22372.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28350.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24714.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18940.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12872.11},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21032.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10047.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41219.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16476.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41599.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10532.44,"maximum":34037.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25192.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18306.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22881.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23197.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20222.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15497.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10532.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17209.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14155.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31277.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10809.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33727.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13481.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34037.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11993.18,"10th_percentile":11993.18,"90th_percentile":11993.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9136.16,"maximum":29550.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21871.09},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15892.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19865.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20139.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17556.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13454.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9143.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14941.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27154.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9136.16},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29281.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29550.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10114.88,"maximum":43905.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32495.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23612.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29514.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29921.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26085.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19990.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17911.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13585.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22198.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10114.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43504.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17390.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43905.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7010.5,"maximum":22655.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16768.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12184.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15230.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15440.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13460.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10315.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7010.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11455.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20818.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8179.25},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22449.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8973.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22655.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4038.45,"maximum":13051.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9659.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7019.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8773.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8894.46},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7753.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5942.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5324.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4038.45},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6598.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5427.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11992.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4362.87},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12932.07},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5169.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13051.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2677.91,"10th_percentile":2677.91,"90th_percentile":2677.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9267.03,"maximum":29948.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22165.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16106.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20132.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20410.12},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13635.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12217.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9267.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15142.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12455.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12229.41},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29675.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29948.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11424.05,"maximum":36919.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27324.78},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19855.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24818.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25160.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21934.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16809.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11424.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18666.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15354.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33925.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12926.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36582.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36919.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":18666.74,"10th_percentile":18666.74,"90th_percentile":18666.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13008.46,"10th_percentile":13008.46,"90th_percentile":13008.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":1635.0,"10th_percentile":1635.0,"90th_percentile":1635.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5779.13,"maximum":18676.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13822.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10044.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12555.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12728.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11096.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8503.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5779.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9443.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17162.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6177.47},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18506.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18676.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6328.65,"10th_percentile":6328.65,"90th_percentile":6328.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":23423.94,"10th_percentile":23423.94,"90th_percentile":23423.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27472.45,"maximum":88783.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65710.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47748.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59684.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60506.58},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52748.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40423.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27472.45},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":44889.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36923.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81583.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32527.56},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87973.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35165.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88783.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12533.01,"maximum":40503.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29977.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21783.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27228.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27603.26},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24063.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18441.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16523.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12533.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20478.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16844.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37218.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14785.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40133.66},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40503.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7656.62,"maximum":24744.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18313.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13307.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16634.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16863.29},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14701.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11266.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7656.62},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12510.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22737.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8599.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24518.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24744.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24045.43,"maximum":77708.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":57513.4},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41792.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52238.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52958.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":46168.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":35381.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31702.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24045.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":39289.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32317.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71406.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26590.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76999.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30778.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77708.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9710.87,"maximum":31382.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23227.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16878.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21096.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21387.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18645.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14288.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12803.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9710.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15867.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13051.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28837.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12511.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31096.51},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31382.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12859.01,"maximum":41556.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30757.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22349.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27936.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28321.28},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":24689.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18921.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12859.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21011.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38186.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13086.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41177.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16459.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41556.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25133.44,"maximum":81224.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60115.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43683.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54602.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55355.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":48257.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":36982.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33136.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25133.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41067.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33780.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74637.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29989.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80483.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32171.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81224.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13061.3,"maximum":42210.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31240.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22701.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28375.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28766.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25078.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19218.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13061.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21341.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17554.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38787.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15508.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41825.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16718.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42210.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9661.77,"maximum":31224.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23109.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16792.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20990.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21279.53},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18550.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14216.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9661.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15787.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12985.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10402.02},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30939.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31224.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1307.96,"maximum":4226.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":3128.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2273.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2841.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":2880.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":2511.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":1924.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":1307.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":2137.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3884.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":1407.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4188.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":1674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4226.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7639.6,"maximum":24689.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18272.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13278.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16597.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16825.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14668.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11241.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10072.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7639.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12483.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10267.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22687.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14825.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24463.82},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24689.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6485.67,"maximum":21164.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15664.26},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11382.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14227.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14423.77},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12574.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9636.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8634.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6548.98},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10700.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19448.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6485.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20971.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8382.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21164.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6265.52,"maximum":20248.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14986.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10889.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13611.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13799.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12030.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9219.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6265.52},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10237.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6485.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20063.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20248.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29647.81,"maximum":95813.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":70913.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51529.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64410.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65297.68},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":56924.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43624.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39088.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29647.81},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":48444.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39847.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88043.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37166.3},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94939.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":37949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95813.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18391.34,"maximum":59435.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43989.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31965.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39955.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40505.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":35312.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27061.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24247.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18391.34},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30051.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24718.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21363.31},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58893.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":23541.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59435.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8593.41,"maximum":27771.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20554.26},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14935.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18669.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18926.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16499.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12644.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11329.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8593.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14041.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11549.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25519.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9912.67},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27518.13},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27771.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10700.68,"maximum":34581.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25594.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18598.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23247.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23567.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20545.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15745.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14108.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10700.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17484.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14382.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31777.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11097.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34266.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34581.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5796.8,"maximum":18733.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13865.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10075.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12593.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12767.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11130.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8529.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5796.8},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9471.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17214.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6477.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18562.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18733.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11008.36,"maximum":35575.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26330.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19133.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23915.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24245.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21136.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16198.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14513.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11008.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17987.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14795.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32691.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12772.13},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35251.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14090.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35575.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4361.84,"maximum":14096.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10432.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7581.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9476.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9606.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6418.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4361.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7127.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5862.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12953.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4759.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13967.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14096.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10267.31,"maximum":33181.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24558.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17845.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22305.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22613.19},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19713.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15107.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13536.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10267.31},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16776.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30490.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10998.87},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32878.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33181.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":35110.03,"10th_percentile":35110.03,"90th_percentile":35110.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"1 through 10","median_amount":13429.61,"10th_percentile":13429.61,"90th_percentile":13915.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":509.03,"10th_percentile":509.03,"90th_percentile":509.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5610.89,"maximum":18132.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13420.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9752.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12189.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12357.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10773.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8256.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5610.89},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9168.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7541.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16662.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5893.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17967.39},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18132.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6389.05,"10th_percentile":6389.05,"90th_percentile":6389.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6333.13,"10th_percentile":6333.13,"90th_percentile":6333.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":6000.0,"10th_percentile":6000.0,"90th_percentile":6000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11985.08,"maximum":38732.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28666.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20830.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26037.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26396.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23011.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17635.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15801.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11985.08},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19583.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16108.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35591.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13720.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38379.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15341.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38732.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6561.42,"maximum":21204.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15694.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11404.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14254.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14451.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12598.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9654.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8650.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6561.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10721.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8818.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19485.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7573.38},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21011.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21204.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4506.51,"maximum":14563.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10778.97},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7832.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9925.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8652.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6631.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5941.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4506.51},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7363.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13382.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5191.24},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14430.93},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14563.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11452.2,"maximum":37010.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27392.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19904.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24879.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25222.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21988.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16851.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15098.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11452.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18712.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15392.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34009.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12054.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36672.67},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14659.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37010.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6505.96,"maximum":21530.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15935.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11579.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14473.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14673.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12791.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9803.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8783.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6662.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10885.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19784.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6505.96},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21334.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21530.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":139768.06,"maximum":451691.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":334306.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":242925.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303646.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":307831.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":268360.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":205658.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184274.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":139768.06},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":228379.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187852.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":415063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":149915.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":447570.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":178906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":451691.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46567.06,"maximum":151745.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":112310.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81610.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102010.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103415.99},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":90155.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":69091.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61906.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46955.08},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":76723.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63108.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139440.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46567.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":150361.31},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":60103.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151745.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21084.52,"maximum":68139.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50431.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36646.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45806.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46437.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40483.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31024.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27798.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21084.52},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34451.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28338.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62613.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22111.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67517.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68139.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23604.88,"maximum":82385.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60975.38},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44308.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55383.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56146.58},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":48947.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":37510.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33610.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25492.84},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":41654.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34263.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75705.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23604.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81634.11},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":32631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82385.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13604.27,"maximum":46767.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34613.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25152.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31439.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31872.43},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27785.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21293.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19079.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14471.38},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23646.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42975.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13604.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46340.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18523.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46767.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13485.5,"maximum":43581.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32255.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23438.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29297.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29701.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25892.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19842.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17779.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13485.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22035.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18124.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40047.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14525.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43183.78},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17261.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43581.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23753.47,"maximum":76764.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56815.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41285.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51604.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52315.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45607.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34951.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31317.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23753.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38812.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31925.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70539.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27470.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76064.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30405.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76764.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15298.19,"maximum":49439.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36591.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26589.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33235.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33693.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29373.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22510.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20169.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15298.19},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24997.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20561.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45430.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17077.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48988.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19582.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49439.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13274.05,"maximum":42898.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31749.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23071.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28837.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29235.38},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25486.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19531.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17500.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13274.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21689.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17840.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39419.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14513.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42506.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16991.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42898.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10137.69,"maximum":32762.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24247.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17619.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22024.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22327.71},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19464.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14916.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13365.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10137.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16564.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30105.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10938.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32463.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12976.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32762.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7507.37,"maximum":24261.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17956.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13048.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16309.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16534.56},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14414.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11046.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9897.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7507.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12266.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10090.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8170.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24040.37},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24261.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8309.95,"maximum":26855.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19876.27},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14443.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18053.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18302.21},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15955.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12227.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10956.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8309.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13578.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11168.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24677.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9000.1},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26610.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26855.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":18324.95,"10th_percentile":18324.95,"90th_percentile":18324.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5240.36,"maximum":16935.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12534.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9108.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11384.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11541.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10061.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7710.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6909.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5240.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8562.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5860.25},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16780.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6707.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16935.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5886.8,"10th_percentile":5886.8,"90th_percentile":5886.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7788.2,"maximum":25169.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18628.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13536.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16919.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17153.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14953.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11459.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7788.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12725.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10467.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23128.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8185.26},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24939.68},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25169.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24425.61,"10th_percentile":24425.61,"90th_percentile":24425.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4109.15,"maximum":13279.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9828.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7141.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8927.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9050.18},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7889.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6046.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5417.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4109.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6714.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12202.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5569.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13158.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5259.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13279.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3639.78,"maximum":11762.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8705.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6326.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7907.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8016.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":6988.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5355.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4798.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3639.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":5947.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4891.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10808.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4408.72},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11655.43},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4659.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11762.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44064.2,"maximum":142403.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":105395.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76586.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95729.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97049.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":84605.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":64837.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58095.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":44064.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":72000.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59223.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130855.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45707.12},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":141104.05},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":56403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142403.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24633.95,"maximum":79610.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58921.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42815.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53517.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54254.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":47298.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":36247.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24633.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":40251.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33108.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73154.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29491.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78883.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":31532.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79610.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49882.61,"maximum":161206.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":119312.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86699.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108370.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":109863.72},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":95776.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":73398.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65766.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":49882.61},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":81507.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67043.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":56630.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":159735.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":63851.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161206.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27585.71,"maximum":89149.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65981.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47945.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59930.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60756.01},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":52965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":40590.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36369.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":27585.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":45074.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37075.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81920.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31503.0},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88335.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":35310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89149.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19273.14,"maximum":62285.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46098.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33497.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41870.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42448.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":37005.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":28359.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25410.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19273.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":31492.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25903.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57234.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21051.36},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61717.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62285.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17896.44,"maximum":57836.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42805.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31105.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38880.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39415.93},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34361.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26333.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23595.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17896.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":29242.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24053.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53146.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20484.58},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57308.65},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57836.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10032.95,"maximum":32423.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23997.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17437.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21796.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22097.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19263.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14762.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10032.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16393.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29794.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11226.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32127.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32423.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6156.85,"maximum":19897.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14726.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10701.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13375.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13560.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11821.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9059.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6156.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10060.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18283.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6893.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19715.7},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19897.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40072.23,"maximum":129502.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":95847.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69648.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87057.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88256.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":76940.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":58963.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52832.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":40072.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":65477.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53858.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119000.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43618.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":128320.81},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":51293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129502.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17265.37,"maximum":55796.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41296.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30008.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37509.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38026.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":33150.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":25404.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17265.37},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28211.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23205.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51272.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21927.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55287.82},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55796.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18892.79,"maximum":61056.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45188.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32836.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41044.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41610.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":36274.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":27799.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24908.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18892.79},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":30870.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25392.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56105.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20099.71},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60499.22},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":24183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61056.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8477.54,"maximum":27397.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20277.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14734.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18417.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18671.31},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12474.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11177.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8477.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13852.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25175.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10087.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27147.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10851.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27397.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5909.4,"maximum":19097.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14134.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10270.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12838.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13015.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8695.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5909.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9655.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17548.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6872.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18923.3},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19097.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8495.21,"maximum":27454.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20319.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14765.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18455.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18710.24},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16311.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12500.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8495.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13881.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25227.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9775.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27203.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10874.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27454.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30714.21,"maximum":99259.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":73464.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53383.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66726.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67646.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":58972.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":45193.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30714.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":50186.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41280.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91210.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":33841.53},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98354.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":39315.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99259.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34973.95,"10th_percentile":34973.95,"90th_percentile":34973.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16094.23,"maximum":52012.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38495.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27972.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34964.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35446.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":30901.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":23681.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16094.23},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":26297.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21631.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47794.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18326.45},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51537.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":20601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52012.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11220.46,"maximum":36261.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26837.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19501.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24376.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24712.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21543.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16510.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14793.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11220.46},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18334.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15080.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33320.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12306.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35930.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36261.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22443.54,"maximum":72531.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53681.89},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39008.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48758.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49430.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":43092.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":33024.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29590.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":22443.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":36672.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30164.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66649.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":25059.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71869.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":28728.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72531.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10759.6,"maximum":34772.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25735.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18700.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23375.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23697.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20658.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15831.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14185.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10759.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17581.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31952.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12916.46},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34454.79},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13772.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34772.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12496.35,"maximum":40384.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29889.56},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21719.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27148.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27522.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23993.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":18387.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16475.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12496.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":20418.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16795.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37109.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14080.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40016.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15995.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40384.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23696.59,"maximum":84287.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62383.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45331.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56661.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57442.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":50077.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":38376.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34386.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":26081.35},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":42616.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35054.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77452.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23696.59},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83518.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":33384.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84287.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12169.03,"maximum":39326.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29106.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21150.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26437.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26801.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23365.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17905.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16043.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12169.03},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19884.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16355.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36137.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13392.29},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38968.12},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15576.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39326.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8876.86,"maximum":28687.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21232.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15428.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19285.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19550.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17043.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13061.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11703.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8876.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14504.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26361.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10242.66},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28425.83},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11362.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28687.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7064.83,"maximum":22831.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16898.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12279.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15348.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15559.91},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13564.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10395.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7064.83},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11543.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20980.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7822.94},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22623.27},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22831.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4935.96,"maximum":15951.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11806.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8579.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10723.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10871.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9477.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7262.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6507.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4935.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8065.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6634.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14658.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5331.06},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15806.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6318.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15951.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4413.56,"maximum":14263.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10556.62},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7671.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9588.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9720.62},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8474.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6494.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5818.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4413.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7211.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5931.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13106.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4711.66},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14133.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14263.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14453.71,"maximum":46710.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34571.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25121.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31400.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31833.5},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":27751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21267.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14453.71},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23617.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19426.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42922.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16008.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46284.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46710.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12554.97,"10th_percentile":12554.97,"90th_percentile":12554.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8287.04,"maximum":26781.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19821.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14403.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18003.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18251.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15911.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12193.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10925.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8287.04},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13540.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11138.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24609.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9139.92},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26537.06},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10607.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26781.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6851.42,"maximum":22141.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16387.66},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11908.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14884.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15089.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13155.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10081.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6851.42},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11195.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20346.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7031.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21939.88},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22141.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9193.05,"maximum":29709.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21988.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15978.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19971.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20247.2},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17651.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13526.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9193.05},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15021.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12355.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10075.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29438.34},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11767.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29709.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6776.05,"10th_percentile":6776.05,"90th_percentile":6776.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6010.87,"maximum":19425.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14377.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10447.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13058.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13238.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":11541.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8844.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6010.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9821.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17850.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6545.05},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19248.23},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19425.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9985.16,"maximum":32269.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23883.15},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17354.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21692.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21991.78},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":19171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14692.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13164.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9985.16},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16315.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13420.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29652.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11915.95},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31974.86},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32269.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11369.99,"10th_percentile":11369.99,"90th_percentile":11369.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13147.98,"maximum":44992.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33299.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24197.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30245.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30662.76},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26731.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20485.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18355.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13922.14},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22748.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41344.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13147.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44582.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17820.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44992.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6638.01,"maximum":21452.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15877.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11537.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14421.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14619.85},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12745.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9767.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6638.01},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10846.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19712.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7613.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21256.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8496.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21452.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4137.3,"maximum":13370.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9895.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7190.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8988.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9112.18},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":7943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6087.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5454.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4137.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":6760.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12286.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5381.42},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13248.62},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5295.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13370.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14936.17,"maximum":48269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35725.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25960.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32448.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32896.11},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28678.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21977.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19692.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14936.17},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24405.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20074.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44355.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":18914.28},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47829.18},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48269.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7588.54,"maximum":24524.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18150.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13189.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16486.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16713.35},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14570.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11165.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10004.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7588.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12399.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22535.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9575.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24300.31},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9713.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24524.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5629.21,"maximum":18192.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13464.31},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9783.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12229.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12398.04},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10808.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8282.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7421.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5629.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9198.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16716.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5997.81},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18026.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7205.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18192.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38393.09,"maximum":124075.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":91831.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66729.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83409.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84558.69},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":73716.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":56492.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50618.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38393.09},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":62733.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51601.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114014.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42972.43},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":122943.8},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":49144.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124075.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14654.68,"maximum":47359.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35052.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25470.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31837.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32276.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28137.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21563.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14654.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":23945.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19696.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43519.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16780.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46927.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18758.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47359.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7881.82,"maximum":25471.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18852.23},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13699.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17123.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17359.27},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15133.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11597.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7881.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12878.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10593.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23406.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9504.49},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25239.45},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10088.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25471.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30013.75,"maximum":96996.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71788.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52165.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65205.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66103.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":57627.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":44163.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39570.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30013.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":49042.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40339.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89130.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31798.41},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96111.16},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38418.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96996.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14831.43,"maximum":47931.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35474.76},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25778.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32221.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32665.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":28476.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":21823.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19554.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14831.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24234.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19933.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44044.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17477.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47493.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":18984.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47931.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8833.66,"maximum":28547.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21128.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15353.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19191.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19455.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16960.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12998.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11646.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8833.66},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14434.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10181.78},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28287.47},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28547.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30622.56,"maximum":98963.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":73244.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53224.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66527.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67444.52},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":58796.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":45058.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40373.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":30622.56},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":50036.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41157.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90938.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":37697.76},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98060.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":39197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98963.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15129.95,"maximum":48895.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36188.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26296.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32869.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33322.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":29050.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":22262.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19947.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15129.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":24722.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20335.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44930.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17410.88},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48449.69},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":19366.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48895.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7850.39,"maximum":25370.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18777.07},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13644.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17055.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17290.07},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15073.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11551.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10350.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7850.39},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12827.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10551.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23313.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8662.59},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25138.83},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10048.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25370.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11153.69,"maximum":36045.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26678.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19385.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24231.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24565.39},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21415.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16411.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11153.69},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18224.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14990.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33122.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12412.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35716.76},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36045.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20686.5,"maximum":66852.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49479.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35954.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44941.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45560.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":39718.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":30438.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20686.5},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":33801.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27803.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61431.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23602.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66243.08},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66852.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9852.27,"maximum":31839.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23565.29},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17123.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21404.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21699.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18916.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14496.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9852.27},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16098.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13241.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29257.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10364.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31549.32},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12611.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31839.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7872.0,"maximum":25440.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18828.75},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13682.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17101.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17337.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15114.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11583.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10378.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7872.0},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12862.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23377.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8107.08},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25208.01},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10076.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25440.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4723.85,"maximum":15266.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11298.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8210.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10262.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10404.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9069.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6950.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4723.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7718.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6348.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5378.41},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15126.9},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15266.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3423.09,"maximum":11062.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8187.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5949.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7436.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7539.17},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":6572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":5036.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3423.09},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":5593.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4600.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10165.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":3999.8},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10961.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":4381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35938.86,"maximum":116144.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":85960.85},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62464.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78077.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79153.38},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":69004.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":52881.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":35938.86},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":58723.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48302.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106726.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":43918.07},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":115084.77},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":46002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116144.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13654.4,"maximum":44127.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32659.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23732.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29664.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30073.06},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26216.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20091.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18002.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13654.4},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22311.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18351.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40548.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15245.98},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43724.63},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44127.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7983.29,"maximum":25799.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19094.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13875.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17343.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17582.75},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15328.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11746.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10525.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7983.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13044.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10729.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23707.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9904.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25564.38},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25799.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31450.68,"maximum":101639.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":75225.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54663.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68326.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69268.4},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":60386.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":46277.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":31450.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":51389.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42270.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93397.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45032.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100712.54},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":40257.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101639.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13664.87,"maximum":44161.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32684.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23750.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29687.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30096.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26237.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20106.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18016.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13664.87},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22328.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18365.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40580.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16446.44},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43758.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17491.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44161.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9452.29,"maximum":30547.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22608.59},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16428.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20535.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20818.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18148.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13908.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9452.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15444.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28070.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9593.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30268.48},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12099.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30547.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21176.82,"maximum":68437.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50652.06},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36806.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46006.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46640.79},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":40660.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":31160.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27920.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21176.82},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":34602.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28462.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62887.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":24018.32},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67813.21},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":27106.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68437.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10679.73,"maximum":34513.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25544.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18562.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23201.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23521.53},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":20505.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":15714.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14080.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10679.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":17450.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14353.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31715.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12115.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34199.04},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":13670.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34513.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6614.44,"maximum":21376.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15820.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11496.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14369.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14567.95},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12699.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9732.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8720.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6614.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10807.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19642.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8618.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21181.02},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21376.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13058.68,"maximum":42201.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31234.58},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22696.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28370.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28761.03},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25073.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19214.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13058.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21337.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17551.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38779.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14340.93},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41816.99},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42201.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7969.54,"maximum":25755.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19062.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13851.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17313.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17552.47},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15301.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11726.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10507.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7969.54},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13022.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23666.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9080.54},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25520.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25755.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5574.88,"maximum":18016.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13334.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9689.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12111.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12278.37},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8203.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5574.88},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9109.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7492.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16555.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6508.97},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17852.09},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7135.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18016.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16971.44,"maximum":54846.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40593.37},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29497.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36870.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37378.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32585.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24972.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22375.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16971.44},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27731.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50399.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19744.15},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54346.58},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21723.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54846.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8563.95,"maximum":27676.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20483.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14884.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18605.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18861.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16443.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12601.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11290.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8563.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13993.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25432.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9891.62},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27423.8},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27676.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5560.48,"maximum":17969.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13299.91},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9664.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12080.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12246.65},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10676.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8181.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5560.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9085.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16512.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7377.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17805.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17969.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15979.64,"maximum":57322.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42425.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30828.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38534.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39065.57},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":34056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":26099.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17737.36},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":28982.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52673.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15979.64},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56799.25},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":22704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57322.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56688.2,"maximum":183200.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":135590.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98527.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123155.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":124852.67},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":108843.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":83412.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74739.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":56688.2},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":92627.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76190.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168344.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":181529.1},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":72562.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183200.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32329.85,"maximum":104481.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":77328.6},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56191.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70236.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71204.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":62074.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":47571.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42624.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32329.85},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":52826.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43452.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96008.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":38326.18},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103527.87},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":41383.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104481.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30224.98,"10th_percentile":30224.98,"90th_percentile":30224.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":32329.85,"10th_percentile":32329.85,"90th_percentile":32329.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"1 through 10","median_amount":189735.84,"10th_percentile":189735.84,"90th_percentile":189735.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34627.34,"10th_percentile":34627.34,"90th_percentile":34627.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":59081.16,"10th_percentile":59081.16,"90th_percentile":59081.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13080.28,"maximum":42271.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31286.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22734.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28416.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28808.61},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25114.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19246.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13080.28},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21373.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38844.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16245.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41886.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":16743.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42271.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"1 through 10","median_amount":21373.0,"10th_percentile":21373.0,"90th_percentile":21373.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":43134.98,"10th_percentile":43134.98,"90th_percentile":43134.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9801.21,"maximum":31674.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23443.16},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17035.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21293.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21586.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18818.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14421.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9801.21},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":16015.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29106.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12052.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31385.8},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31674.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29777.43,"maximum":96232.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71223.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51755.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64691.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65583.16},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":57173.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":43815.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39259.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29777.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":48655.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40021.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88428.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":33267.99},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95354.4},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":38115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96232.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11846.95,"maximum":38286.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28336.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20590.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25737.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26092.25},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22746.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17431.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15619.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11846.95},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19357.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15922.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35181.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13567.43},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37936.74},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38286.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7480.53,"maximum":24174.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17892.4},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13001.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16251.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16475.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14362.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11007.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9862.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7480.53},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12223.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22214.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8324.33},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23954.42},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9575.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24174.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4292.45,"maximum":13871.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10266.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7460.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9325.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9453.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8241.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6316.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4292.45},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7013.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12747.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4438.04},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13745.44},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5494.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13871.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7660.55,"maximum":24756.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18322.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13314.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16642.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16871.94},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14708.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11271.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10099.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7660.55},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12517.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22749.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9436.84},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24530.9},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24756.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4726.47,"maximum":15274.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11305.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8214.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10268.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10409.8},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":9075.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6954.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4726.47},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7722.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14036.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5748.25},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15135.29},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15274.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9707.6,"maximum":31372.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23219.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16872.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21089.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21380.45},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18638.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14284.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9707.6},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15862.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13047.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28828.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10729.01},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31086.03},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31372.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5310.41,"maximum":17161.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12701.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9229.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11536.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11695.88},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10196.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":7813.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7001.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5310.41},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":8677.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15770.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6032.39},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17005.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":6797.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17161.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6930.63,"maximum":22397.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16577.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12045.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15056.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15264.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13307.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10197.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9137.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6930.63},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11324.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20581.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8072.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22193.53},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22397.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4399.15,"maximum":14216.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10522.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7646.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9557.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9688.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":8446.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":6473.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4399.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":7188.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13063.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4747.74},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14087.14},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":5631.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14216.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13943.75,"maximum":45062.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33351.54},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24235.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30292.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30710.34},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":26772.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":20517.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13943.75},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22783.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18740.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41408.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16476.51},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44651.19},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17848.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45062.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8808.13,"maximum":28465.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21067.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15309.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19135.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19399.42},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16911.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":12960.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8808.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14392.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11838.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26157.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10329.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28205.72},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28465.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23399.96,"maximum":75622.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55969.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40670.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50836.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51537.14},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":44928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34431.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23399.96},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38235.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31450.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69489.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":32480.21},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74932.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":29952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75622.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13489.43,"maximum":43594.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32264.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23445.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29305.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29709.73},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25900.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19848.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17784.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13489.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":22041.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18130.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40059.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14937.03},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43196.36},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17266.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43594.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9613.33,"maximum":31067.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22993.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16708.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20885.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21172.83},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18457.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14145.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9613.33},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15708.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28548.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10365.19},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30784.17},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12305.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31067.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23454.3,"maximum":75797.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56099.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40765.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50954.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51656.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":45033.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":34511.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30922.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23454.3},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":38323.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31523.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69651.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":28147.41},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75106.24},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":30022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75797.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11846.29,"maximum":38283.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28334.72},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20589.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25736.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26090.81},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":22745.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17430.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15618.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11846.29},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19356.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35179.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13417.09},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37934.64},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15163.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38283.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9335.76,"maximum":30170.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22329.87},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16226.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20281.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20561.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17925.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13736.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9335.76},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15254.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12547.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27724.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9993.85},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29895.33},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11950.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30170.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12011.26,"maximum":38817.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28729.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20876.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26094.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26454.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23062.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17673.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15835.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12011.26},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19626.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35669.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12699.97},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38462.91},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38817.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8122.07,"maximum":26248.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19426.88},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14116.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17645.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17888.41},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":15594.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":11951.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10708.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8122.07},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":13271.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24119.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8633.27},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26008.79},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":10396.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26248.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13083.34,"maximum":43350.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32084.81},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23314.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29142.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29543.92},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":25755.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":19737.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17685.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13414.15},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":21918.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18028.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39835.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13083.34},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42955.28},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":17170.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43350.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7446.48,"maximum":24064.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17810.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12942.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16177.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16400.48},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":14297.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10956.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9817.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7446.48},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":12167.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10008.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22113.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8007.86},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23845.41},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24064.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11371.68,"maximum":36750.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27199.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19764.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24705.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25045.51},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":21834.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":16732.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14992.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11371.68},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":18581.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33770.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12260.23},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36414.83},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":14556.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36750.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5627.91,"maximum":18187.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13461.18},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9781.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12226.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12395.15},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":10805.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":8281.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7419.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5627.91},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":9195.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16712.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7007.35},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18021.89},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":7203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18187.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9081.77,"maximum":29349.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21722.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15784.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19730.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20002.09},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17437.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13363.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9081.77},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":14839.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12206.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26969.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9935.22},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29081.97},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29349.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16808.43,"maximum":54320.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40203.48},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29214.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36516.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37019.66},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":32272.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":24732.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16808.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":27464.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49915.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19484.82},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53824.6},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":21515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54320.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9661.12,"maximum":31222.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23108.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16791.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20988.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21278.08},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":18549.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":14215.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12737.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9661.12},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15786.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12984.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28690.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10006.63},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30937.2},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":12366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31222.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12056.43,"maximum":38963.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28837.34},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20954.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26192.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26553.63},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":23148.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":17740.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15895.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12056.43},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":19700.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16204.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35803.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":13244.2},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38607.56},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":15432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38963.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7121.13,"maximum":23013.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17032.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12376.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15470.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15683.9},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":13672.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":10478.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9388.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7121.13},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":11635.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21147.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7695.9},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22803.55},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":9115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23013.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6287.78,"maximum":20320.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15039.51},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10928.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13660.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13848.49},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12072.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":9252.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6287.78},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":10274.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18672.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":6590.91},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20134.96},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8048.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20320.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9373.73,"maximum":30293.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22420.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16292.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20364.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20645.13},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":17997.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerigroup","plan_name":"Wellpoint Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Hmo","methodology":"fee schedule","standard_charge_dollar":13792.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12358.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9373.73},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"fee schedule","standard_charge_dollar":15316.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12598.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27836.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10676.4},{"payer_name":"Private Healthcare Systems","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30016.92},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30293.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70712.42,"maximum":70712.42,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":70712.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82927.29,"10th_percentile":82927.29,"90th_percentile":82927.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46041.63,"maximum":46041.63,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":46041.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"1 through 10","median_amount":44000.0,"10th_percentile":44000.0,"90th_percentile":44000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36181.58,"maximum":36181.58,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":36181.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41907.92,"10th_percentile":41907.92,"90th_percentile":41907.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41508.79,"10th_percentile":41508.79,"90th_percentile":41508.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51506.48,"maximum":51506.48,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":51506.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29770.33,"maximum":29770.33,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":29770.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42437.53,"10th_percentile":42437.53,"90th_percentile":42437.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31303.16,"10th_percentile":31303.16,"90th_percentile":31303.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"1 through 10","median_amount":69737.88,"10th_percentile":69737.88,"90th_percentile":69737.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8656.58,"maximum":8656.58,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":8656.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12104.63,"maximum":12104.63,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12104.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19229.24,"maximum":19229.24,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":19229.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9302.29,"maximum":9302.29,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9302.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12899.92,"maximum":12899.92,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":12899.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21875.22,"maximum":21875.22,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21875.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4337.31,"maximum":4337.31,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":4337.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9560.87,"maximum":9560.87,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9560.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14407.08,"maximum":14407.08,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":14407.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23276.39,"maximum":23276.39,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23276.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15294.84,"maximum":15294.84,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":15294.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23849.94,"maximum":23849.94,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":23849.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39307.9,"maximum":39307.9,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":39307.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50271.44,"maximum":50271.44,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":50271.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42462.03,"maximum":42462.03,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":42462.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55597.24,"maximum":55597.24,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":55597.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45123.8,"maximum":45123.8,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":45123.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62726.36,"maximum":62726.36,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":62726.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9088.8,"maximum":9088.8,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":9088.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16138.25,"maximum":16138.25,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16138.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11948.27,"maximum":11948.27,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11948.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20215.47,"maximum":20215.47,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":20215.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10866.58,"maximum":10866.58,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10866.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17208.67,"maximum":17208.67,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":17208.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10461.41,"maximum":10461.41,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":10461.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11594.97,"maximum":11594.97,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":11594.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7231.35,"maximum":7231.35,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":7231.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5570.85,"maximum":5570.85,"payers_information":[{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":5570.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":9971.3,"10th_percentile":9971.3,"90th_percentile":9971.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":11043.81,"10th_percentile":11043.81,"90th_percentile":11043.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cath coronary drug-delivery","code_information":[{"code":"2050","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":395.0,"10th_percentile":395.0,"90th_percentile":395.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":653.49,"10th_percentile":653.49,"90th_percentile":653.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":127.08,"10th_percentile":127.08,"90th_percentile":127.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.27,"10th_percentile":128.27,"90th_percentile":466.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":740.09,"10th_percentile":653.49,"90th_percentile":892.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":193.95,"10th_percentile":193.95,"90th_percentile":193.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":125.81,"10th_percentile":125.81,"90th_percentile":127.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":155.48,"10th_percentile":155.48,"90th_percentile":155.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":117.63,"10th_percentile":117.63,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":261.4,"10th_percentile":167.7,"90th_percentile":261.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":43.73,"10th_percentile":43.73,"90th_percentile":43.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":67.13,"10th_percentile":67.13,"90th_percentile":67.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":624.86,"10th_percentile":624.86,"90th_percentile":624.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.82,"10th_percentile":86.82,"90th_percentile":86.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":391.19,"10th_percentile":391.19,"90th_percentile":391.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":224.03,"10th_percentile":224.03,"90th_percentile":224.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":503.98,"10th_percentile":503.98,"90th_percentile":503.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":302.31,"10th_percentile":302.31,"90th_percentile":302.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":156.16,"10th_percentile":156.16,"90th_percentile":156.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"16","median_amount":82.94,"10th_percentile":82.94,"90th_percentile":326.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.62,"10th_percentile":158.62,"90th_percentile":158.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":853.98,"10th_percentile":853.98,"90th_percentile":2009.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":665.69,"10th_percentile":665.69,"90th_percentile":665.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":853.98,"10th_percentile":491.43,"90th_percentile":3002.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":155.7,"10th_percentile":155.7,"90th_percentile":259.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":665.51,"10th_percentile":665.51,"90th_percentile":665.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"20","median_amount":680.0,"10th_percentile":680.0,"90th_percentile":680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":184.64,"10th_percentile":184.28,"90th_percentile":184.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":853.98,"10th_percentile":853.98,"90th_percentile":853.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":2228.0,"10th_percentile":1782.0,"90th_percentile":2444.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"15","median_amount":273.04,"10th_percentile":273.04,"90th_percentile":377.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"39","median_amount":338.01,"10th_percentile":178.44,"90th_percentile":543.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":276.61,"10th_percentile":276.61,"90th_percentile":277.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"28","median_amount":2124.22,"10th_percentile":1443.66,"90th_percentile":2358.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"32","median_amount":665.69,"10th_percentile":665.69,"90th_percentile":665.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"20","median_amount":3002.0,"10th_percentile":1125.69,"90th_percentile":3002.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":271.41,"10th_percentile":86.82,"90th_percentile":357.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":1219.23,"10th_percentile":1219.23,"90th_percentile":1219.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"46","median_amount":680.0,"10th_percentile":680.0,"90th_percentile":680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"43","median_amount":184.64,"10th_percentile":184.64,"90th_percentile":184.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":2270.0,"10th_percentile":1868.02,"90th_percentile":2270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"18","median_amount":3073.0,"10th_percentile":2143.54,"90th_percentile":6138.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"38","median_amount":641.31,"10th_percentile":419.89,"90th_percentile":894.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"100","median_amount":2124.22,"10th_percentile":1443.66,"90th_percentile":2358.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"26","median_amount":665.69,"10th_percentile":665.69,"90th_percentile":665.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"40","median_amount":3023.98,"10th_percentile":2699.02,"90th_percentile":3106.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"1 through 10","median_amount":8793.16,"10th_percentile":8793.16,"90th_percentile":8793.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":567.17,"10th_percentile":271.41,"90th_percentile":903.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"27","median_amount":1607.36,"10th_percentile":1607.36,"90th_percentile":1607.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"92","median_amount":680.0,"10th_percentile":680.0,"90th_percentile":680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"39","median_amount":184.64,"10th_percentile":184.28,"90th_percentile":184.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"27","median_amount":3677.0,"10th_percentile":1963.61,"90th_percentile":3768.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"23","median_amount":4291.67,"10th_percentile":2228.0,"90th_percentile":13623.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"78","median_amount":1138.03,"10th_percentile":691.39,"90th_percentile":2705.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"25","median_amount":1428.62,"10th_percentile":730.91,"90th_percentile":2193.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":1223.57,"10th_percentile":697.89,"90th_percentile":2826.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"152","median_amount":2130.15,"10th_percentile":2130.15,"90th_percentile":8478.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"20","median_amount":665.69,"10th_percentile":665.69,"90th_percentile":665.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"49","median_amount":3033.19,"10th_percentile":2574.16,"90th_percentile":3367.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":713.64,"10th_percentile":713.64,"90th_percentile":713.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"148","median_amount":1061.2,"10th_percentile":502.74,"90th_percentile":2781.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"28","median_amount":2051.37,"10th_percentile":2051.37,"90th_percentile":5738.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"97","median_amount":680.0,"10th_percentile":680.0,"90th_percentile":5224.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"31","median_amount":184.64,"10th_percentile":184.28,"90th_percentile":184.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"32","median_amount":5552.0,"10th_percentile":3753.06,"90th_percentile":5553.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":2630.52,"10th_percentile":2630.52,"90th_percentile":2630.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1776.8,"10th_percentile":1776.8,"90th_percentile":1776.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2344.62,"10th_percentile":2344.62,"90th_percentile":2344.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":195.93,"10th_percentile":195.93,"90th_percentile":323.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":197.77,"10th_percentile":197.77,"90th_percentile":2510.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":971.74,"10th_percentile":551.8,"90th_percentile":3184.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":128.57,"10th_percentile":128.57,"90th_percentile":128.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":194.37,"10th_percentile":193.97,"90th_percentile":397.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":971.74,"10th_percentile":971.74,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1349.0,"10th_percentile":1349.0,"90th_percentile":1349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3043.0,"10th_percentile":3043.0,"90th_percentile":3043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"12","median_amount":393.97,"10th_percentile":393.97,"90th_percentile":521.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":399.3,"10th_percentile":397.67,"90th_percentile":525.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"22","median_amount":2868.04,"10th_percentile":2868.04,"90th_percentile":3184.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":2922.0,"10th_percentile":2922.0,"90th_percentile":2922.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":390.43,"10th_percentile":390.03,"90th_percentile":517.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":1233.72,"10th_percentile":1233.72,"90th_percentile":1233.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"11","median_amount":1500.0,"10th_percentile":1500.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1349.0,"10th_percentile":1349.0,"90th_percentile":1349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1790.23,"10th_percentile":1790.23,"90th_percentile":1790.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":3614.1,"10th_percentile":3614.1,"90th_percentile":3614.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3184.89,"10th_percentile":3184.89,"90th_percentile":3184.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":688.22,"10th_percentile":688.22,"90th_percentile":688.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1702.0,"10th_percentile":1702.0,"90th_percentile":1702.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":2931.47,"10th_percentile":2931.47,"90th_percentile":2931.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2394.25,"10th_percentile":2394.25,"90th_percentile":2394.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1619.29,"10th_percentile":1619.29,"90th_percentile":1619.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3107.04,"10th_percentile":3107.04,"90th_percentile":3107.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1660.18,"10th_percentile":1593.79,"90th_percentile":1664.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":2232.38,"10th_percentile":2232.38,"90th_percentile":2232.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":2830.07,"10th_percentile":2830.07,"90th_percentile":2830.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3750.25,"10th_percentile":3750.25,"90th_percentile":3750.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":6620.38,"10th_percentile":6620.38,"90th_percentile":6620.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":3400.98,"10th_percentile":3400.98,"90th_percentile":3400.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1992.32,"10th_percentile":1992.32,"90th_percentile":1992.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3860.97,"10th_percentile":3860.97,"90th_percentile":3860.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3710.06,"10th_percentile":3710.06,"90th_percentile":3710.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":10565.02,"10th_percentile":10565.02,"90th_percentile":10565.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":12289.43,"10th_percentile":12289.43,"90th_percentile":12289.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6378.1,"10th_percentile":6378.1,"90th_percentile":6378.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":155.59,"10th_percentile":155.59,"90th_percentile":155.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.26,"10th_percentile":160.26,"90th_percentile":160.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":952.76,"10th_percentile":952.76,"90th_percentile":1606.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":154.18,"10th_percentile":154.03,"90th_percentile":231.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1500.0,"10th_percentile":1500.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3107.04,"10th_percentile":3107.04,"90th_percentile":3107.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1563.45,"10th_percentile":1563.45,"90th_percentile":1563.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1603.41,"10th_percentile":1603.41,"90th_percentile":5716.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1480.12,"10th_percentile":1480.12,"90th_percentile":1480.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3654.66,"10th_percentile":3654.66,"90th_percentile":5377.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":6352.94,"10th_percentile":6352.94,"90th_percentile":6352.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3173.85,"10th_percentile":3173.85,"90th_percentile":3173.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":4090.32,"10th_percentile":4090.32,"90th_percentile":4090.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":5574.28,"10th_percentile":4920.46,"90th_percentile":5615.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":1410.51,"10th_percentile":1410.51,"90th_percentile":1410.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7286.97,"10th_percentile":7286.97,"90th_percentile":7286.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":13097.36,"10th_percentile":13097.36,"90th_percentile":14602.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":6933.39,"10th_percentile":6933.39,"90th_percentile":6933.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7097.33,"10th_percentile":6986.48,"90th_percentile":7171.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":2440.89,"10th_percentile":2440.89,"90th_percentile":2440.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":19058.94,"10th_percentile":19058.94,"90th_percentile":28523.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":20868.2,"10th_percentile":20868.2,"90th_percentile":24493.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":12886.4,"10th_percentile":12886.4,"90th_percentile":12886.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12994.97,"10th_percentile":12994.97,"90th_percentile":12994.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":29249.56,"10th_percentile":16179.26,"90th_percentile":46446.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":18105.19,"10th_percentile":18105.19,"90th_percentile":18105.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12746.82,"10th_percentile":12742.08,"90th_percentile":12782.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":27782.76,"10th_percentile":27782.76,"90th_percentile":27782.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":32398.26,"10th_percentile":32398.26,"90th_percentile":32398.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":25812.58,"10th_percentile":25812.58,"90th_percentile":25812.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":18675.67,"10th_percentile":18675.67,"90th_percentile":18675.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":28965.61,"10th_percentile":28289.52,"90th_percentile":29370.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18175.14,"10th_percentile":18078.47,"90th_percentile":18527.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":57802.38,"10th_percentile":57802.38,"90th_percentile":57802.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":42347.26,"10th_percentile":42347.26,"90th_percentile":42347.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":28824.4,"10th_percentile":28824.4,"90th_percentile":28824.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1666.46,"10th_percentile":1666.46,"90th_percentile":1666.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1440.52,"10th_percentile":1440.52,"90th_percentile":1440.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":2242.86,"10th_percentile":2242.86,"90th_percentile":2242.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":8028.57,"10th_percentile":8028.57,"90th_percentile":8028.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":15704.72,"10th_percentile":15704.72,"90th_percentile":15704.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":694.0,"10th_percentile":694.0,"90th_percentile":694.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1609.35,"10th_percentile":1609.35,"90th_percentile":1609.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":3104.29,"10th_percentile":3104.29,"90th_percentile":3104.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3134.76,"10th_percentile":3134.76,"90th_percentile":3134.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":14877.94,"10th_percentile":14877.94,"90th_percentile":14877.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3085.28,"10th_percentile":3085.28,"90th_percentile":3085.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":8449.27,"10th_percentile":8449.27,"90th_percentile":8449.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":9380.73,"10th_percentile":9380.73,"90th_percentile":9380.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":1064.72,"10th_percentile":1064.72,"90th_percentile":1064.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8408.53,"10th_percentile":8408.53,"90th_percentile":8408.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":3171.64,"10th_percentile":3171.64,"90th_percentile":3195.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3215.96,"10th_percentile":3206.75,"90th_percentile":5711.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":8530.02,"10th_percentile":8530.02,"90th_percentile":9472.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6.0,"10th_percentile":6.0,"90th_percentile":6.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":7102.48,"10th_percentile":7102.48,"90th_percentile":7102.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3144.42,"10th_percentile":3144.42,"90th_percentile":3157.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":4574.41,"10th_percentile":3890.09,"90th_percentile":5970.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":16897.48,"10th_percentile":16897.1,"90th_percentile":16915.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5684.26,"10th_percentile":5684.26,"90th_percentile":5684.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5577.1,"10th_percentile":5577.1,"90th_percentile":5577.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":11200.03,"10th_percentile":11200.03,"90th_percentile":18126.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11347.41,"10th_percentile":11347.41,"90th_percentile":11366.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":16602.56,"10th_percentile":16602.56,"90th_percentile":16602.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":12518.14,"10th_percentile":12518.14,"90th_percentile":12518.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11094.83,"10th_percentile":11089.19,"90th_percentile":17949.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":6320.76,"10th_percentile":6320.76,"90th_percentile":6320.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17550.1,"10th_percentile":17550.1,"90th_percentile":17550.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7806.54,"10th_percentile":7806.54,"90th_percentile":7806.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electrophysiologic Procedures","code_information":[{"code":"5211","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1208.34,"10th_percentile":1208.34,"90th_percentile":1208.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":2105.19,"10th_percentile":2105.19,"90th_percentile":2105.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":24198.15,"10th_percentile":24198.15,"90th_percentile":24198.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":19879.08,"10th_percentile":19879.08,"90th_percentile":19879.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23953.45,"10th_percentile":23953.45,"90th_percentile":23953.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":18340.2,"10th_percentile":18340.2,"90th_percentile":18340.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":44816.98,"10th_percentile":44816.98,"90th_percentile":44816.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":71657.88,"10th_percentile":71657.88,"90th_percentile":71657.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8244.86,"10th_percentile":8244.86,"90th_percentile":8244.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":16521.6,"10th_percentile":16521.6,"90th_percentile":16521.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10417.66,"10th_percentile":10417.06,"90th_percentile":10417.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10224.84,"10th_percentile":10224.84,"90th_percentile":10224.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":3917.75,"10th_percentile":3917.75,"90th_percentile":3917.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31918.47,"10th_percentile":31918.47,"90th_percentile":31918.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":36854.27,"10th_percentile":36854.27,"90th_percentile":36854.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31303.63,"10th_percentile":31303.08,"90th_percentile":31303.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":4267.19,"10th_percentile":4267.19,"90th_percentile":4267.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":795.09,"10th_percentile":795.09,"90th_percentile":795.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":198.1,"10th_percentile":198.1,"90th_percentile":198.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":787.46,"10th_percentile":787.46,"90th_percentile":787.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3043.0,"10th_percentile":3043.0,"90th_percentile":3043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":924.51,"10th_percentile":924.51,"90th_percentile":924.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1467.38,"10th_percentile":1467.38,"90th_percentile":1467.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":2868.04,"10th_percentile":2868.04,"90th_percentile":3640.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":919.76,"10th_percentile":915.26,"90th_percentile":1821.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":7734.6,"10th_percentile":5148.0,"90th_percentile":29650.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":1874.51,"10th_percentile":1874.51,"90th_percentile":1874.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1856.37,"10th_percentile":1856.37,"90th_percentile":1856.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":2105.19,"10th_percentile":2105.19,"90th_percentile":2105.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":5377.58,"10th_percentile":5377.58,"90th_percentile":5377.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":902.95,"10th_percentile":902.95,"90th_percentile":902.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":665.69,"10th_percentile":665.69,"90th_percentile":665.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":893.92,"10th_percentile":893.92,"90th_percentile":893.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":2105.19,"10th_percentile":2105.19,"90th_percentile":2734.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3329.26,"10th_percentile":3329.26,"90th_percentile":3329.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":1624.92,"10th_percentile":1166.6,"90th_percentile":5538.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3107.04,"10th_percentile":3107.04,"90th_percentile":3450.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1159.17,"10th_percentile":1159.17,"90th_percentile":1159.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1500.0,"10th_percentile":1500.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1286.85,"10th_percentile":1286.85,"90th_percentile":1286.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":2812.41,"10th_percentile":2812.41,"90th_percentile":2812.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3450.3,"10th_percentile":3450.3,"90th_percentile":3450.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1996.75,"10th_percentile":1996.75,"90th_percentile":1996.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6099.49,"10th_percentile":6099.49,"90th_percentile":6099.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":341.67,"10th_percentile":341.67,"90th_percentile":341.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":7250.0,"10th_percentile":7250.0,"90th_percentile":8490.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":5768.87,"10th_percentile":5768.87,"90th_percentile":5768.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3070.78,"10th_percentile":3070.78,"90th_percentile":3070.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5827.6,"10th_percentile":5827.6,"90th_percentile":5827.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"19","median_amount":7767.6,"10th_percentile":1734.21,"90th_percentile":9053.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4935.21,"10th_percentile":4935.21,"90th_percentile":4935.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":7997.08,"10th_percentile":7997.08,"90th_percentile":8169.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5708.25,"10th_percentile":5707.9,"90th_percentile":10164.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":6103.73,"10th_percentile":6103.73,"90th_percentile":6103.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":4146.1,"10th_percentile":4146.1,"90th_percentile":4146.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":18975.54,"10th_percentile":18975.54,"90th_percentile":19016.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":6777.79,"10th_percentile":6777.79,"90th_percentile":6777.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":1310.33,"10th_percentile":1310.33,"90th_percentile":1310.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":2408.31,"10th_percentile":2408.31,"90th_percentile":2408.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":656.1,"10th_percentile":656.1,"90th_percentile":656.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":5408.03,"10th_percentile":5408.03,"90th_percentile":5408.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3450.3,"10th_percentile":3450.3,"90th_percentile":3450.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":3408.82,"10th_percentile":3408.82,"90th_percentile":3760.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4442.34,"10th_percentile":4442.34,"90th_percentile":4442.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3382.86,"10th_percentile":3382.86,"90th_percentile":3401.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3138.62,"10th_percentile":3138.62,"90th_percentile":3138.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":5293.98,"10th_percentile":5293.98,"90th_percentile":5653.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5475.5,"10th_percentile":5475.5,"90th_percentile":5561.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":7229.85,"10th_percentile":7229.85,"90th_percentile":7229.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5362.91,"10th_percentile":874.67,"90th_percentile":5534.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1233.9,"10th_percentile":1233.9,"90th_percentile":1233.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1926.74,"10th_percentile":1926.74,"90th_percentile":1926.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":696.0,"10th_percentile":696.0,"90th_percentile":696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":3184.89,"10th_percentile":3184.89,"90th_percentile":3184.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":3132.3,"10th_percentile":3132.3,"90th_percentile":3132.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":685.26,"10th_percentile":684.71,"90th_percentile":685.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":1570.1,"10th_percentile":1570.1,"90th_percentile":1570.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1500.0,"10th_percentile":1500.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":897.67,"10th_percentile":897.67,"90th_percentile":1340.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":2868.04,"10th_percentile":2868.04,"90th_percentile":2868.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":874.33,"10th_percentile":874.33,"90th_percentile":874.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":3824.82,"10th_percentile":3824.82,"90th_percentile":3824.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2300.49,"10th_percentile":2300.49,"90th_percentile":2300.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"11","median_amount":133.32,"10th_percentile":47.97,"90th_percentile":836.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"13","median_amount":86.82,"10th_percentile":86.82,"90th_percentile":86.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":176.85,"10th_percentile":176.85,"90th_percentile":176.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":87.63,"10th_percentile":87.63,"90th_percentile":87.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"41","median_amount":77.73,"10th_percentile":65.84,"90th_percentile":450.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":93.45,"10th_percentile":93.45,"90th_percentile":93.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"12","median_amount":417.53,"10th_percentile":290.32,"90th_percentile":2607.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.84,"10th_percentile":90.84,"90th_percentile":90.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":86.82,"10th_percentile":86.13,"90th_percentile":86.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":138.69,"10th_percentile":138.69,"90th_percentile":579.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"15","median_amount":59.93,"10th_percentile":55.56,"90th_percentile":419.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":319.24,"10th_percentile":159.62,"90th_percentile":1885.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"34","median_amount":334.5,"10th_percentile":69.89,"90th_percentile":550.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"28","median_amount":104.86,"10th_percentile":104.86,"90th_percentile":104.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":421.46,"10th_percentile":290.26,"90th_percentile":3542.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":106.05,"10th_percentile":105.85,"90th_percentile":106.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"77","median_amount":169.57,"10th_percentile":77.73,"90th_percentile":584.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":364.17,"10th_percentile":252.21,"90th_percentile":473.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"25","median_amount":696.43,"10th_percentile":369.27,"90th_percentile":1294.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.1,"10th_percentile":110.1,"90th_percentile":110.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"82","median_amount":104.86,"10th_percentile":103.81,"90th_percentile":104.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":138.69,"10th_percentile":138.69,"90th_percentile":10347.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"30","median_amount":142.94,"10th_percentile":65.42,"90th_percentile":491.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":668.94,"10th_percentile":354.69,"90th_percentile":784.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"18","median_amount":224.16,"10th_percentile":161.8,"90th_percentile":224.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"15","median_amount":1249.36,"10th_percentile":1249.36,"90th_percentile":1531.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":238.36,"10th_percentile":238.36,"90th_percentile":243.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":337.12,"10th_percentile":337.12,"90th_percentile":531.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":241.58,"10th_percentile":240.6,"90th_percentile":435.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"31","median_amount":825.76,"10th_percentile":484.23,"90th_percentile":1487.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1213.28,"10th_percentile":1213.28,"90th_percentile":1486.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":989.0,"10th_percentile":805.64,"90th_percentile":989.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":238.36,"10th_percentile":237.28,"90th_percentile":530.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":565.11,"10th_percentile":565.11,"90th_percentile":3792.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"20","median_amount":804.0,"10th_percentile":491.0,"90th_percentile":804.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1784.81,"10th_percentile":1784.81,"90th_percentile":1784.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":2671.0,"10th_percentile":932.16,"90th_percentile":4297.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"16","median_amount":1420.46,"10th_percentile":558.79,"90th_percentile":4240.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"19","median_amount":540.67,"10th_percentile":540.67,"90th_percentile":540.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2499.44,"10th_percentile":2499.44,"90th_percentile":2499.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":545.75,"10th_percentile":545.75,"90th_percentile":545.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"53","median_amount":643.61,"10th_percentile":579.58,"90th_percentile":1918.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":542.64,"10th_percentile":542.64,"90th_percentile":542.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":2346.97,"10th_percentile":1216.79,"90th_percentile":3632.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":556.35,"10th_percentile":556.35,"90th_percentile":556.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":536.56,"10th_percentile":535.66,"90th_percentile":536.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":966.12,"10th_percentile":966.12,"90th_percentile":966.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":940.01,"10th_percentile":940.01,"90th_percentile":2823.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":2671.0,"10th_percentile":2671.0,"90th_percentile":5040.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1267.5,"10th_percentile":1267.5,"90th_percentile":1267.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":175.54,"10th_percentile":175.54,"90th_percentile":175.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":177.92,"10th_percentile":177.39,"90th_percentile":179.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":590.41,"10th_percentile":584.37,"90th_percentile":899.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":603.0,"10th_percentile":603.0,"90th_percentile":603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.54,"10th_percentile":175.54,"90th_percentile":428.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":491.0,"10th_percentile":491.0,"90th_percentile":491.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":364.44,"10th_percentile":364.44,"90th_percentile":364.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1386.44,"10th_percentile":1042.0,"90th_percentile":2604.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"21","median_amount":352.16,"10th_percentile":352.16,"90th_percentile":766.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":75.66,"10th_percentile":75.66,"90th_percentile":75.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":356.92,"10th_percentile":355.67,"90th_percentile":580.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"22","median_amount":825.76,"10th_percentile":648.93,"90th_percentile":1238.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1336.22,"10th_percentile":1336.22,"90th_percentile":1336.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":989.0,"10th_percentile":748.59,"90th_percentile":989.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":351.89,"10th_percentile":349.94,"90th_percentile":1080.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":565.11,"10th_percentile":565.11,"90th_percentile":565.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"11","median_amount":804.0,"10th_percentile":491.0,"90th_percentile":968.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":9954.94,"10th_percentile":9954.94,"90th_percentile":9954.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":779.06,"10th_percentile":779.06,"90th_percentile":779.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":786.38,"10th_percentile":786.38,"90th_percentile":1123.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":1873.63,"10th_percentile":1873.63,"90th_percentile":2689.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":772.57,"10th_percentile":772.57,"90th_percentile":772.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":2493.99,"10th_percentile":2493.99,"90th_percentile":2493.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1890.25,"10th_percentile":1890.25,"90th_percentile":1890.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":3344.0,"10th_percentile":3344.0,"90th_percentile":3344.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":417.16,"10th_percentile":417.16,"90th_percentile":417.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":396.24,"10th_percentile":396.24,"90th_percentile":396.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":521.25,"10th_percentile":521.25,"90th_percentile":8478.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":1706.77,"10th_percentile":1706.77,"90th_percentile":1706.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":395.53,"10th_percentile":395.53,"90th_percentile":395.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1051.29,"10th_percentile":1051.29,"90th_percentile":1051.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1784.81,"10th_percentile":1784.81,"90th_percentile":1784.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1497.13,"10th_percentile":1497.13,"90th_percentile":1497.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":424.62,"10th_percentile":424.62,"90th_percentile":424.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":767.83,"10th_percentile":767.83,"90th_percentile":767.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":665.51,"10th_percentile":665.51,"90th_percentile":665.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":1086.79,"10th_percentile":1086.79,"90th_percentile":1086.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1569.58,"10th_percentile":1569.58,"90th_percentile":2084.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"12","median_amount":1287.31,"10th_percentile":1287.31,"90th_percentile":1525.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1299.41,"10th_percentile":1299.41,"90th_percentile":1847.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":2198.23,"10th_percentile":1977.36,"90th_percentile":2556.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1277.69,"10th_percentile":1277.01,"90th_percentile":1817.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":6629.91,"10th_percentile":6629.91,"90th_percentile":6629.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":2341.64,"10th_percentile":2341.64,"90th_percentile":3309.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":857.01,"10th_percentile":857.01,"90th_percentile":857.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":52.69,"10th_percentile":52.69,"90th_percentile":52.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53.18,"10th_percentile":53.18,"90th_percentile":53.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":65.18,"10th_percentile":58.71,"90th_percentile":130.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":126.41,"10th_percentile":126.41,"90th_percentile":153.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":283.46,"10th_percentile":283.46,"90th_percentile":441.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.61,"10th_percentile":54.61,"90th_percentile":54.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":68.03,"10th_percentile":68.03,"90th_percentile":68.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":156.14,"10th_percentile":156.14,"90th_percentile":156.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":272.26,"10th_percentile":272.26,"90th_percentile":272.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":44.52,"10th_percentile":44.52,"90th_percentile":44.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":168.97,"10th_percentile":168.97,"90th_percentile":168.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":872.67,"10th_percentile":872.67,"90th_percentile":872.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":916.02,"10th_percentile":916.02,"90th_percentile":916.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":1362.39,"10th_percentile":1362.39,"90th_percentile":1362.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":167.28,"10th_percentile":167.28,"90th_percentile":167.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":955.78,"10th_percentile":955.78,"90th_percentile":955.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":10087.44,"10th_percentile":10087.44,"90th_percentile":10087.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":3038.57,"10th_percentile":3038.57,"90th_percentile":3038.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":4911.9,"10th_percentile":4911.9,"90th_percentile":4911.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":3595.78,"10th_percentile":3595.78,"90th_percentile":3595.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1818.32,"10th_percentile":1818.32,"90th_percentile":1818.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":10121.78,"10th_percentile":10121.78,"90th_percentile":10121.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"18","median_amount":343.96,"10th_percentile":192.05,"90th_percentile":16749.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"22","median_amount":207.76,"10th_percentile":207.76,"90th_percentile":549.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":222.83,"10th_percentile":222.83,"90th_percentile":222.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":210.57,"10th_percentile":209.71,"90th_percentile":356.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"22","median_amount":740.09,"10th_percentile":76.9,"90th_percentile":855.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":920.65,"10th_percentile":400.79,"90th_percentile":3327.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"74","median_amount":206.1,"10th_percentile":205.68,"90th_percentile":331.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":324.1,"10th_percentile":324.1,"90th_percentile":324.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"15","median_amount":283.87,"10th_percentile":143.5,"90th_percentile":3214.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":23709.42,"10th_percentile":23709.42,"90th_percentile":23709.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":8914.39,"10th_percentile":6594.18,"90th_percentile":8914.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":1258.29,"10th_percentile":1258.29,"90th_percentile":1258.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":123.42,"10th_percentile":123.42,"90th_percentile":123.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":945.26,"10th_percentile":945.26,"90th_percentile":945.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":288.05,"10th_percentile":288.05,"90th_percentile":288.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":153.24,"10th_percentile":153.05,"90th_percentile":153.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":327.8,"10th_percentile":327.8,"90th_percentile":327.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":425.54,"10th_percentile":425.54,"90th_percentile":425.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":1148.42,"10th_percentile":1148.42,"90th_percentile":1148.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1207.62,"10th_percentile":1207.62,"90th_percentile":1207.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":281.61,"10th_percentile":281.61,"90th_percentile":281.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1564.48,"10th_percentile":1564.48,"90th_percentile":1564.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":999.0,"10th_percentile":999.0,"90th_percentile":999.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":937.2,"10th_percentile":937.2,"90th_percentile":1019.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":242.37,"10th_percentile":242.37,"90th_percentile":242.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":522.48,"10th_percentile":519.18,"90th_percentile":522.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":957.8,"10th_percentile":957.8,"90th_percentile":957.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":937.2,"10th_percentile":937.2,"90th_percentile":937.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":318.45,"10th_percentile":270.37,"90th_percentile":389.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":58.57,"10th_percentile":46.86,"90th_percentile":58.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.12,"10th_percentile":59.12,"90th_percentile":59.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"29","median_amount":263.17,"10th_percentile":193.27,"90th_percentile":336.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":292.54,"10th_percentile":292.54,"90th_percentile":292.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":817.9,"10th_percentile":655.99,"90th_percentile":1293.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":58.57,"10th_percentile":57.98,"90th_percentile":58.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":370.91,"10th_percentile":370.91,"90th_percentile":370.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":219.75,"10th_percentile":219.75,"90th_percentile":219.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1310.81,"10th_percentile":1310.81,"90th_percentile":1310.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1612.47,"10th_percentile":1587.13,"90th_percentile":1661.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":829.05,"10th_percentile":829.05,"90th_percentile":829.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"1 through 10","median_amount":127.11,"10th_percentile":127.11,"90th_percentile":127.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":116.67,"10th_percentile":116.67,"90th_percentile":116.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.3,"10th_percentile":128.3,"90th_percentile":222.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"13","median_amount":258.48,"10th_percentile":95.04,"90th_percentile":318.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"1 through 10","median_amount":1744.05,"10th_percentile":1744.05,"90th_percentile":1744.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":126.34,"10th_percentile":125.84,"90th_percentile":127.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":169.7,"10th_percentile":169.7,"90th_percentile":169.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":309.74,"10th_percentile":222.04,"90th_percentile":426.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":1675.51,"10th_percentile":1675.51,"90th_percentile":1675.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":2114.49,"10th_percentile":2114.49,"90th_percentile":2114.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":658.94,"10th_percentile":651.34,"90th_percentile":1221.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":1859.19,"10th_percentile":1215.58,"90th_percentile":1878.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":640.11,"10th_percentile":640.02,"90th_percentile":1278.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":5161.26,"10th_percentile":5161.26,"90th_percentile":5161.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Instill, bupivac and meloxic","code_information":[{"code":"9440","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"1 through 10","median_amount":535.75,"10th_percentile":535.75,"90th_percentile":535.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":653.49,"10th_percentile":653.49,"90th_percentile":653.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":261.4,"10th_percentile":167.7,"90th_percentile":261.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"61","median_amount":328.54,"10th_percentile":15.15,"90th_percentile":721.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"73","median_amount":24.24,"10th_percentile":4.29,"90th_percentile":93.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9.03,"10th_percentile":5.53,"90th_percentile":22.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":17.71,"10th_percentile":4.33,"90th_percentile":78.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"58","median_amount":27.73,"10th_percentile":5.06,"90th_percentile":110.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"16","median_amount":84.69,"10th_percentile":84.69,"90th_percentile":1024.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"191","median_amount":12.76,"10th_percentile":4.25,"90th_percentile":92.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"13","median_amount":155.48,"10th_percentile":42.58,"90th_percentile":266.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"50","median_amount":7.29,"10th_percentile":7.29,"90th_percentile":170.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":768.44,"10th_percentile":605.46,"90th_percentile":825.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":16.13,"10th_percentile":3.86,"90th_percentile":319.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"1 through 10","median_amount":266.44,"10th_percentile":266.44,"90th_percentile":266.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"50","median_amount":40.17,"10th_percentile":40.17,"90th_percentile":102.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"17","median_amount":99.75,"10th_percentile":99.75,"90th_percentile":99.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":36.46,"10th_percentile":36.46,"90th_percentile":36.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":100.7,"10th_percentile":100.7,"90th_percentile":100.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"52","median_amount":255.74,"10th_percentile":255.74,"90th_percentile":284.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":39.01,"10th_percentile":39.01,"90th_percentile":39.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"19","median_amount":87.47,"10th_percentile":87.47,"90th_percentile":87.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":98.75,"10th_percentile":98.75,"90th_percentile":98.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"1 through 10","median_amount":244.26,"10th_percentile":244.26,"90th_percentile":244.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"18","median_amount":297.96,"10th_percentile":297.96,"90th_percentile":297.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":84.02,"10th_percentile":84.02,"90th_percentile":84.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"1 through 10","median_amount":250.46,"10th_percentile":250.46,"90th_percentile":250.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":76.26,"10th_percentile":76.26,"90th_percentile":76.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4733] [Arthroscopy ($): 8307] [Bariatric Surgery ($): 15538] [Cardiac Cath ($): 9149] [Laparoscopy ($): 7250] [Lithotripsy ($): 15404] [Observation (%BC): 39.5 Maximum Reimbursement 9749] [Emergency Department ($): 2228] [CT Scan OP ($): 845] [MRI OP ($): 1302] [Positron Emission Tomography ($): 6911] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Trauma ($): 5910] [All Other OP (%BC): 27.2]","count":"1 through 10","median_amount":1360.79,"10th_percentile":1360.79,"90th_percentile":1360.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3184.89] [Ablation ($): 11753.56] [Cardiac Cath ($): 9472.39] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 40925.78] [Insertion of Permanent Pacemaker ($): 15227.73] [Joint Replacement-Full/Partial ($): 46446.26] [Lap Banding ($): 25857.29] [PTCA w/ Drug Eluting Stent ($): 16602.56] [PTCA w/non Drug Eluting Stent ($): 15824.91] [PTCA w/out stent ($): 14995.51] [Spinal Surgery ($): 28823.52] [Stereotactic Radiosurgery ($): 36724.38] [Stereotactic Radiosurgery-Fractionated ($): 9289.24] [Observation ($): 9415.18] [ED Level 1--99281 ($): 624.86] [ED Level 2--99282 ($): 2009.88] [ED Level 3--99283 ($): 2358.90] [ED Level 4--99284 ($): 2358.90] [ED Level 5--99285 ($): 2365.48] [Urgent Care ($): 181.80] [Cardiac Rehabilitation Therapy ($): 205.69] [Cardiac Stress Test ($): 1275.29] [Cardiology ($): 967.42] [Echocardiology ($): 643.61] [EKG/ECG ($): 248.16] [Electrophysiology Ablation ($): 9378.16] [Electrophysiology and Mapping Studies ($): 9299.86] [Holter Monitor/Telemetry ($): 570.63] [Peripheral Vascular Lab ($): 88.92] [EEG ($): 842.68] [EMG ($): 690.06] [Neuropsychological Testing and Biofeedback ($): 1301.83] [Sleep Studies ($): 2961.94] [Brachytherapy ($): 25387.52] [Chemotherapy ($): 1983.91] [Oncology ($): 460.49] [Radiation Therapy ($): 630.35] [CT Scan OP ($): 648.93] [MRI OP ($): 916.99] [Mammography-Diagnostic ($): 142] [Mammography-Screening ($): 142] [Positron Emission Tomography ($): 3486.13] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 983.33] [Peritoneal Dialysis, CAPD, and CCPD ($): 1856.51] [Occupational Therapy ($): 208.34] [Physical Therapy ($): 347.67] [Resp. Services/Therapy ($): 663.51] [Speech Therapy ($): 144.64] [Mental Health ($): 1094.80] [Mental Health-Intensive ($): 995.29] [Mental Health-Partial Hospitalization ($): 1142.59] [OP ECT Mental Health ($): 843.99] [OP High Cost Drugs (%BC): 0 Charge Threshold 4551.23 (%BC): 29.73] [Ambulance--Air  (%BC): 55.06] [Ambulance--Land  (%BC): 55.06] [Hyperbarics ($): 1061.63] [Pulmonary Function ($): 1049.69] [Trauma (%BC): 34.77] [All Other OP (%BC): 36.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5845] [OP Surg. Minor ($): 2922] [Bariatric Surgery ($): 6614] [Cardiac Cath ($): 6713] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 14217] [Lap Chole ($): 6614] [Laparoscopy ($): 10742] [Lithotripsy ($): 16685] [PTCA ($): 10655] [Stereotactic Radiosurgery ($): 36128] [Observation (%BC): 23.3 Maximum Reimbursement 10267] [Emergency Department ($): 3002] [CT Scan OP ($): 603] [MRI OP ($): 989] [Positron Emission Tomography ($): 3646] [Radiology (%BC): 23.30] [Laboratory (%BC): 23.30] [OP High Cost Drugs (%BC): 34.40] [Other Outpatient Implant (%BC): 34.40] [All Other OP (%BC): 23.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":59.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2985] [Bariatric Surgery ($): 11033] [Cardiac Cath ($): 5799] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 10589] [Joint Replacement-Full/Partial ($): 17863] [Laparoscopy ($): 13771] [Lithotripsy ($): 9180] [PTCA ($): 10327] [Stereotactic Radiosurgery ($): 12113] [Observation ($): 5939] [ED Level 1--99281 ($): 574] [ED Level 2--99282 ($): 689] [ED Level 3--99283 ($): 1262] [ED Level 4--99284 ($): 1663] [ED Level 5--99285 ($): 2123] [Clinic Visit (%BC): 19] [Electrophysiology and Mapping Studies ($): 16697] [Nuclear Medicine ($): 689] [CT Scan OP ($): 459] [MRI OP ($): 585] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 1721] [Radiology ($): 144] [Ultrasound Imaging ($): 115] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 29] [Other Outpatient Implant (%BC): 0 Charge Threshold 2000 (%BC): 47] [Trauma (%BC): 33] [All Other OP (%BC): 19]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 2800] [OP Surg. Minor ($): 1500] [Cardiac Cath ($): 3200] [Observation ($): 4500] [Emergency Department ($): 680] [All Other OP (%BC): 18 Maximum Reimbursement 7820]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5045] [Cardiac Cath ($): 16538] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91854] [Insertion of Permanent Pacemaker ($): 43961] [PTCA w/ Drug Eluting Stent ($): 19989] [PTCA w/non Drug Eluting Stent ($): 22307] [PTCA w/out stent ($): 16538] [Stereotactic Radiosurgery ($): 45462] [Stereotactic Radiosurgery-Fractionated ($): 22006] [Observation ($): 9749] [ED Level 1--99281 ($): 1096] [ED Level 2--99282 ($): 2126] [ED Level 3--99283 ($): 2225] [ED Level 4--99284 ($): 3677] [ED Level 5--99285 ($): 5441] [Critical Care-99291 ($): 5441] [Urgent Care ($): 768] [Cardiac Rehabilitation Therapy ($): 1309] [Cardiac Stress Test ($): 1965] [Cardiology ($): 5892] [Echocardiology ($): 2618] [EKG/ECG ($): 1571] [Electrophysiology Ablation ($): 49209] [Electrophysiology and Mapping Studies ($): 41991] [Holter Monitor/Telemetry ($): 2356] [Peripheral Vascular Lab ($): 1649] [EEG ($): 3534] [EMG ($): 984] [Neuropsychological Testing and Biofeedback ($): 294] [Sleep Studies-Attended ($): 3534] [Sleep Studies-Unattended ($): 3534] [Chemotherapy ($): 1277] [Nuclear Medicine ($): FEE SCHEDULE] [Oncology ($): 591] [Radiation Therapy ($): 2356] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic ($): FEE SCHEDULE] [Mammography-Screening ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 491] [Peritoneal Dialysis, CAPD, and CCPD ($): 491] [Occupational Therapy ($): 392] [Physical Therapy ($): 392] [Resp. Services/Therapy ($): 295] [Speech Therapy ($): 392] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Ambulance--Air ($): 1099] [Ambulance--Land ($): 1099] [Hyperbarics ($): 1965] [IV Therapy ($): 62] [Pulmonary Function ($): 690] [Pulmonary Rehabilitation ($): 152]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350606 | Total % of Charge: 29.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13892 Days: 4 Additional Days: 4316] [Normal vag. Del. 3 day stay-Case Rate: 12279 Days: 3 Additional Days: 4316] [Nursery  Level 1- Boarder-Per Diem: 1247] [Nursery  Level 2-Per Diem: 7164] [Nursery  Level 3-Per Diem: 7164] [Nursery  Level 4-NICU-Per Diem: 7164] [Rehab-Per Diem: 3268] [Cardiac Cath-Case Rate: 8713] [Trauma-Case Rate: 5910]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 333204.28 | Excess % of Charge: 45.16] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 13653.93 Days: 4 Additional Days: 3265.07] [Normal vag. Del. 2 day stay-Case Rate: 11427.74 Days: 2 Additional Days: 3265.07] [Alcohol/ Chemical Dependency-Per Diem: 1777.52] [Psych-Per Diem: 1777.52] [Rehab-Per Diem: 2481.12] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2600.71 (%BC): 44.05] [Trauma-Case Rate: 2287.09]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350176 | Total % of Charge: 21.5] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 12649 Days: 1 Additional Days: 2710] [Surgical-Case Rate: 12321 Days: 1 Additional Days: 3286] [C-Section 4 day stay-Case Rate: 10719 Days: 4 Additional Days: 2594] [Normal vag. Del. 2 day stay-Case Rate: 8338 Days: 2 Additional Days: 2594] [Nursery  Level 1- Boarder-Per Diem: 972] [Nursery  Level 2-Per Diem: 3797] [Nursery  Level 3-Per Diem: 3797] [Nursery  Level 4-NICU-Per Diem: 3797] [Alcohol/ Chemical Dependency-Per Diem: 2527] [Psych-Per Diem: 2527] [Rehab-Per Diem: 2527] [SNF-Per Diem: 2527] [IP High Cost Drugs (%BC): 34.40] [IP Prosthetics/Implants/Devices (%BC): 34.40] [Cardiac Cath-Case Rate: 17802 Days: 1 Additional Days: 3160] [Trauma  (%BC): 46.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9165.49,"10th_percentile":9165.49,"90th_percentile":9165.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 307977 | Total % of Charge: 19] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7953 Days: 4 Additional Days: 1351] [Normal vag. Del. 3 day stay-Case Rate: 6546 Days: 3 Additional Days: 1351] [Nursery  Level 1- Boarder-Per Diem: 1520] [Nursery  Level 2-Per Diem: 4819] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 4819] [Rehab-Per Diem: 1747] [SNF-Per Diem: 1563] [IP High Cost Drugs (%BC): 0 Charge Threshold 2000 (%BC): 33] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 2000 (%BC): 40] [Trauma  (%BC): 33]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 202500 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [Medical-Case Rate: 6000 Days: 3 Additional Days: 1220] [Surgical-Case Rate: 8700 Days: 3 Additional Days: 1220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2272] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5643 Days: 4 Additional Days: 1040] [Normal vag. Del. 2 day stay-Case Rate: 3908 Days: 2 Additional Days: 1040] [Nursery  Level 1- Boarder-Per Diem: 1054] [Nursery  Level 2-Per Diem: 3005] [Nursery  Level 3-Per Diem: 3005] [Nursery  Level 4-NICU-Per Diem: 3005] [Rehab-Per Diem: 3181] [Hospice-Per Diem: 5205] [Bariatric Surgery-Case Rate: 19448 Days: 4 Additional Days: 5205]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys setup","code_information":[{"code":"1008T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitoring cont","code_information":[{"code":"95250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st setup&edu","code_information":[{"code":"98975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param setup","code_information":[{"code":"99453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.67,"additional_payer_notes":"APC"}]}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.37,"maximum":384.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":207.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed 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